Episode Transcript
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Speaker 1 (00:01):
Hello and welcome to
another episode of the Med
School Minutes podcast, where wediscuss what it takes to attend
and successfully complete amedical program.
This show is brought to you bySt James School of Medicine.
Here is your host, Kaushik Guha.
Speaker 2 (00:19):
Thank you so much for
joining us on another episode
of Med School Minutes, where wetalk about everything md related
, with the focus oninternational students,
specifically students from thecaribbean.
Today we have dr jason giles,who is an md board certified
addictionologist, uh as ourguest.
He's going to about his journeyand how he ended up where he is
(00:47):
today as one of the country'sleading addiction ologists.
So, without further ado, let'swelcome dr Jason Giles.
Well, thank you so much, drGiles, really appreciate you
taking the time out of your busyschedule and talking to us a
little bit about your careertrajectory, and one thing I
(01:12):
really want to start with Ialways start with is if you
could give us a background aboutyourself.
Speaker 3 (01:18):
Sure, thanks for
having me on your show.
I appreciate it very much.
And yeah, so I'm a medicaldoctor, I'm a, I'm a physician.
I went to uh, I went to ucberkeley for college and then uc
davis for medical school.
Loved it, loved both.
I had a hard time decidingbetween research and clinical
(01:40):
medicine.
Not so much I like I likedresearch.
I was in an amazing lab at calbut clinical medicine not so
much.
I liked research.
I was in an amazing lab at Calbut clinical medicine won and I
was one of those.
You may have some listeners thatknew what they wanted to do
when they first went in, but Iwas not one of them.
So I loved everything.
I loved when I was onpediatrics I wanted to be a
(02:01):
pediatrician and when I was oninternal medicine I was going to
be an internal medicine doctorand so forth.
It was all interesting to me.
I started off in generalsurgery but wound up getting
recruited into anesthesiologyand I think that was mostly
because of this interest in allsorts of things.
You know, anesthesia is everykind of patient with every kind
(02:24):
of medical problem having everykind of surgery, so that that
three-dimensional mix ofinteresting patients, that that
was fun to me and challengingand hard, and I liked it.
Um, what I didn't know this isthis this will play out later
and what I wound up choosing todo for a career.
But what I didn't know is I hada lurking substance use problem
(02:50):
which would go away when I wasbusy with school, which was all
the time.
I mean all the time fromcollege, all the way through.
You have to get the grades andtake the tests and so forth, so
mostly that thing was undercontrol.
Through you have to get thegrades and take the tests and
and so forth.
So mostly that thing was undercontrol and by the time I got to
some relatively easy rotationsin anesthesia, I started and I
(03:12):
don't have a great answer forthis because it doesn't make any
sense why somebody would dothis but I got curious, probably
the safest way or best way tosay it.
I got curious about the thesesubstances and so I tried them
and probably the worst thingthat could possibly happen
happened, which is nothing.
Nothing bad happened.
Speaker 2 (03:32):
Okay.
Speaker 3 (03:33):
First time I tried it
and when nothing bad happened,
I thought well, okay, this is auseful tool for managing my
feelings, for managing myboredom, for managing my boredom
, for managing my yawning fearthat I'm going to become a
doctor out in the world soon andI'm not sure how to do this and
(03:54):
I don't feel the normal things.
They're normal that, standingwith your toes over the diving
board at the end of, at the endof training and about to go out
into the world, it's normal tohave second thoughts and to feel
inadequate.
I didn't realize that thosewere all normal thoughts and I
wasn't asking anybody about them.
I didn't say, hey, you everfeel like you know, you don't
know anything and or can'treally help anybody, which turns
(04:17):
out to be quite common, reallyquite common, well, basically
universal.
Since then I've realized it'suniversal, but at the time I
thought it was especially badand I thought I wasted all this
time and I was going to be aterrible doctor.
And so to manage those feelings, I use these substances very
rarely and then, very rarely,became, you know, not very often
(04:40):
, and then not very often.
Became not all the time, andthen not all the time.
Became well, not every day, andthen not every day became well,
not you know, all the time,every day.
And so I was getting close tothe point where I was going to
start using these things at work.
(05:00):
It was after work that I wasusing these chemicals that's
part of my justification andfortunately I got a call from
the chairman of the department,who had been unbeknownst to me,
paying attention to themedications that were being
signed out and I was AI wouldprobably have picked this up a
lot sooner.
This is back in the late 20thcentury and so we had to rely on
(05:25):
the pharmacists havingpaperwork and eventually going
hey, this is like two timesstandard deviation for fentanyl
use.
And so I got a call from thechairman who said hey, we're not
saying you did any of this, butwe need all the medicine back
in the pharmacy by six o'clocktonight.
(05:46):
And I said can I talk to you?
He said I was hoping you wouldsay that, and that began the
journey of recovery.
So I went to recovery, dealtwith myself as a patient rather
than as a doctor, which is acompletely different, totally
different and learned a lot.
Learned a lot about myself,learned a lot about myself,
learned a lot about my familywent back to anesthesia.
(06:07):
I went back, finished myresidency, worked as a cardiac
anesthesiologist.
That's what I've been trainingfor.
I had done a fellowship also inpain medicine in between there
and that was interesting to mepain management.
So I was doing both.
I was doing cardiac anesthesiaon call for heart heart surgery
service in california and alsoopening a pain clinic super busy
(06:31):
about five years sober.
I got a call from an old friendof mine who had a treatment
center in southern californiaand uh said hey, you know a lot
about this stuff, can you comehelp us?
I said, well, you know, I'm alittle bit busy with this.
He said, well, just check itout and see what you think.
So I did.
I thought, well, if I'm goingto explore a new something else,
(06:55):
and I liked it because it savedmy life and I, um, I tried it
out and it turns out it was theperfect job for me and I started
working in the addictiontreatment field and then I quick
(07:16):
, you know, had to get formaltraining in that.
So I got involved with the, withthe board, uh, with the society
that granted it and it's it'sstill a new specialty.
There's just now fellowships init and so forth.
There's still no residenciesyet in addiction medicine, but
there will be someday.
And so I had this experienceand I had already been boarded
in anesthesia and so I starteddoing addiction medicine
(07:37):
full-time at this place inSouthern California.
And then, 20 years later, hereI am still doing it.
The only thing that's the onlything that's changed.
I've done it consistently since2005 and I have not gone back
to anesthesia.
The only thing that changed isfive years ago we had all these
lockdowns right because of allthe virus fears and so forth,
and so our specialty ofaddiction medicine went like
(08:00):
this you know, videos and andinterviews by telemedicine right
and so I started, uh doing thesame work, but doing it by
telemedicine, and that's that'sbeen enormously rewarding
because reach more people, Ihave a much bigger team of folks
that can help treat patientsand I feel like you know anyone
(08:23):
any one of your listeners who'sin medicine, who's either in
medical school or finished.
It's an enormous privilege tobe a doctor, enormous privilege,
right?
Just because just becauseyou're a doctor doesn't mean you
can't be a patient also and gothrough whatever you need to do
to get well, whether that's yourgallbladder or broken leg or
substance use disorder.
But the for most of us, for mefor sure, it's a sense of
(08:50):
calling or honor or duty to dothis job and to help.
For me, help as many people aspossible, and with telemedicine
and my experiences, my team andI get to help a lot, a lot more
people.
So I was, it was a fortune,fortunate, uh consequence of a
(09:11):
bad time in the, in the world,in the country and in the world.
And now, um, now we have manyuh treatment facilities where we
bring medical care, and excitedabout about the future and the
implications there.
So there you go, there's,there's, there's, dr giles.
A little bit of a nutshell alittle bit of a background well.
Speaker 2 (09:32):
Thank you so much, dr
giles.
Would you uh quickly tell usabout all the books that you've
written about uh?
Speaker 3 (09:39):
yes, I wrote a couple
.
I wrote.
I wrote a memoir, uh, memoirkind of.
It's more than that, it's sortof a.
I tried to cram everything inthere.
There's probably too muchinformation in there, but it's a
bit of that story that I told.
It starts in the operating roomwith me promising myself that
today I'm going to stop, whichis a promise that I had made and
(10:02):
broken many days in a row whenI was dependent on fentanyl.
But the back half of the bookgoes into practical solutions.
You know, not everyone can getto a treatment center.
In fact, 90% of people don't goto a treatment center.
(10:22):
So, um, it's, uh, it'spractical tips on on on drugs
that you might be addicted to,or, um, problems that you might
have, things that you shoulddefinitely seek medical care for
, and so forth.
So it's a.
It's a, it's kind of a manual.
I wrote it that way, uh, tomake the story relatable.
My intent is geez, if this guycan make it, then maybe anybody
(10:51):
can.
Right, doctors aren't immune.
That was the primary intent.
And then the other is well, I'msuffering, or my loved one is
suffering, what do I do?
So that's that book.
And then the other book is it'scalled Outsmart your Addiction.
Then the other book is is, um,it's called outsmart your
addiction.
The other one is uh, uh, thebehavioral health tech manual,
(11:12):
so that that's a?
Uh kind of an inside baseballmanual for the people that take
care of the patients at thetreatment facilities.
They're the, they're the uh,they're the lowest, um, you know
credential level person in thetreatment centers and this is
not well known.
But unfortunately there's a bigturnover.
It's a tough job.
It's a hard job.
They don't have medicaltraining.
They're thrown into thesepositions where they're taking
(11:34):
care of sometimes very sickpeople in withdrawal and because
this is a bit of a catch 22,because they don't know what
they're doing.
Oftentimes they're newly soberthemselves many cases you know,
a year sober and they're like Iwant to give back and be in the
field, but they don't understandthe symptoms of withdrawal.
(11:55):
They don't understand what'sdangerous and what isn't, or how
to report a medical.
You know all the stuff that youlearned in the first two weeks
of medical school.
They don't have any of that, ornursing school.
So it was my idea that if wecould help them learn how to be
better at their job, then theywould stick around, and so
that's what that manual is aboutthat just came out earlier this
(12:16):
year.
Okay, unless you're abehavioral health tech, it's
probably not that helpful foryou, but it's what to do when
you don't know what to do.
That's what that's about, andthere's another one in the
series coming out for nursing.
That's going to be a bit moretechnical.
Speaker 2 (12:29):
Okay.
Speaker 3 (12:30):
But that's in part of
the teaching mission.
I think people need information, right, they need knowledge.
So those are my two books sofar Awesome, working on a couple
others.
Speaker 2 (12:44):
Well, congratulations
.
Obviously, you've accomplisheda lot, despite some initial
hurdles in your career.
Speaker 3 (12:54):
Despite and maybe
later.
Because, right, because it'sall.
You never know what God's planis and I would not have picked
that for sure, right, I said Iwant to go through this tumult
in order to have this life.
I probably would have balked,but, um, but I had a lot of help
, I had great people I had.
(13:14):
I had terrific people, had gonethrough it before me, I had
lots of other physicians so I, Ibelieved it was possible.
Uh, and things just kept openingup.
You know, the longer I kept atit, the longer I stayed healthy,
the more the world opened up.
Speaker 2 (13:29):
Right.
So I want to go back on a termthat you used when you were
introducing yourself, sayingthat when you were in med school
, you had a lurking addiction.
Speaker 3 (13:39):
Yes.
Speaker 2 (13:40):
What does?
Speaker 3 (13:40):
that mean.
That means that therelationship to the substances
so drinking, for example, backin high school, was not exactly
entirely, I'll say, healthy, notentirely healthy.
(14:02):
I'll say healthy, not entirelyhealthy.
You know, half of the country,half of the US, either doesn't
drink at all or drinks less thanonce a month.
That's about 50% of the country, so that's probably the most
normal.
There's another 25% of thecountry that occasionally will
(14:23):
drink more than one drink andthat number is two.
So 75% of the country eitherdoesn't drink at all or hardly
drinks at all.
25% of the country has somesort of something more than that
right.
So averaging more than onedrink a day puts you in alcohol
use disorder category.
It doesn't have to be every day.
Use disorder category doesn'thave to be every day, but
(14:47):
drinking every day does,although some people have a
glass of wine with dinner everyday and they don't have a
problem relationship to alcohol.
And and so it's not that every,it's not that every time I
interacted with just picking onalcohol, it's not that every
time I interacted with it that Iwas always um, you know, drank
(15:10):
to the point of excess orblacked out or any of that.
In fact, that that I don'tthink ever happened, but
probably the best way to say itis, I expected it to do more for
me than than maybe others doand and I probably would have
discovered this problem earlierif my life just weren't so
(15:32):
packed and that there was noroom for drinking.
There was, there was, there wasno room for drinking.
So it's only it's only late inmy training when I caught a
little bit of a you know things.
You start to get mastery oversomething.
I had been there a couple ofyears, I'd gotten it.
I was on a relatively easyrotation and then had this sense
(15:55):
of you know, something's notright and this curiosity and
also this probably special sensethat I can handle this.
I can handle this because of mytraining right, because I'll be
careful that that kind of thing.
Um, but looking back, so this isone of those things where if
you had said to me, uh, in my,in my senior year of medical
(16:18):
school, uh, or in my internship,uh, or maybe even in college,
do you, do you think you've gota problem relationship to
substances like alcohol?
I would have said no.
I would have said no.
My friends and I, we drinksometimes, but mostly not
because I'm busy with school anddon't have time for it.
That's why I would haveanswered the question.
But on those occasions I wasnot in the first 75 percentile
(16:47):
of people who take it or leaveit no big deal that sort of
stuff.
If I was going to drink, it waswith an unhealthy relationship
to it.
So I figured that out post hocthat this is a pattern that had
been established for a while.
So it's a good question.
You know you ask people, do youhave a problem?
(17:08):
Then they may not.
They may not know.
You know I always I'm fond ofsaying well, you know, take a
look, ask yourself the question,give yourself a chance to
answer it privately, think aboutit for yourself.
Do you have a problemrelationship to alcohol or do
you have a problem relationshipto marijuana?
That's another very common oneand most people will tell you if
they do or not, and I would nothave been able to accurately
(17:31):
answer that question until later.
Oh, pattern started a long timeago.
Oh, work and overwork is a is away to deal with those feelings
, right, it's a way to getvalidation.
It's a way to be so busy that Iright, it's a way to get
validation.
It's a way to be so busy that Idon't have to worry about how I
feel, if that makes sense.
A lot of doctors fall into thatpattern.
Speaker 2 (17:55):
I mean, you know,
considering you just used some
statistics about the UnitedStates, I mean USA a lot of
people work long hours, they,you know, and I'd like to focus
a little bit on the termrecreational, like.
Speaker 3 (18:14):
Yeah, there you go,
that's it.
That's a slippery word, sure.
Speaker 2 (18:18):
Right and a lot of
people say that, oh, I
recreationally use marijuana orI recreationally drink.
But it almost seems like theway you're describing it, as you
mentioned, that this was alurking addiction.
Was that, even if this is not aregular occurrence, when you're
indulging in it you'reoverindulging?
(18:41):
Is that typically a sign for alurking addiction?
Speaker 3 (18:46):
Yes, I would pay
attention to that.
Yes, binge drinking is the mostcommon form of alcohol use
disorder.
So, even though the federalcriteria or the ASAM criteria
are this number of drinks perweek or how often you're
drinking, some people don'tdrink, don't drink very often,
but when they drink, it's veryexcessively and so, yes, I would
(19:09):
take a look at that if you're,if you're drinking to the point
of stupor or you know,incapacity or uh, hungover here.
Here's how.
Here's how it came to me.
I learned about this from acounselor and and I was
explaining how I didn't reallyhave a problem with this this is
just this fentanyl thing got melike it gets some people.
(19:32):
And he said, well, did you everuse?
Do you ever drink?
And I said, yeah, you know, Imean sure, in college and with
friends and whatever.
And when would you drink?
And I said, well, vacation.
That's the only time you have.
Is vacation?
He says, well, typically, whatwould that look like?
And I explained, and it wasdefinitely in the, in the, not
(19:56):
every day, but definitely youwould have to go wait a minute.
In the context of what thiseventually became, which was an
opiate use disorder, is it, um,is it wiser or or uh.
Safer to consider um or saferto consider that?
Maybe this problem is as my sonthe economist would say what if
(20:25):
substituted goods?
Right, so alcohol is available,fentanyl is available, but the
actual issue is the substanceuse disorder.
And I said no, I would justdrink around vacation, basically
, or a day off.
We had a long weekend off.
Sometimes you get that inresidency, but not not very
often.
And and he said Did you everthink that your drinking was
ruining your vacation?
And I had not.
Speaker 2 (20:50):
Interesting right.
Speaker 3 (20:51):
So vacation is time
renewal and time of doing stuff
you haven't got to, andrelaxation and hanging out with
friends and so forth.
And the drinking muddies, allof that drinking the way I was
drinking muddies all of that andthat's what it is.
That is, that you know we cansave up and and not drink for
(21:12):
extended stretches of time.
In the early stages of thisproblem, people focus on the
issues at the end, when you'recompulsively consuming
substances or compulsivelygambling or compulsively doing
whatever the other dependenciesare.
But there's this time.
So a simple way to think of itis fun, fun with problems and
(21:34):
then just problems.
So I got to the latter stagestop being fun, but that middle
period there where it's fun withproblems, that's when that's so
.
That's the right answer to yourquestion is if you're at home
or if you're, you're at the gymlistening to this podcast and
you think, well, I mean, I don'tdrink that much, but when I do
I drink the whole bottle of wine.
It's worth a peek right.
(21:56):
It's worth an honestconversation with yourself about
your relationship.
Speaker 2 (22:02):
Right, that's how it
is.
So when it comes to othersubstances like, for example,
let's take marijuana, this is arelatively new drug, newly
legalized.
Well, it's not officiallylegalized.
Speaker 3 (22:17):
Is it legal on the
island of St James?
Speaker 2 (22:20):
St Vincent.
Yes, it is actually.
That's a huge economic driveractually in St Vincent and
they've been giving out growinglicenses.
It's also a part of the culturealso.
It's they've been using it forcenturies, but you know I mean.
(22:42):
so we're headquartered inIllinois, in Chicago mm-hmm and
Chicago it's like every blockthere seems to be a marijuana
dispensary nowadays and this isa drug that it seems like has
very little, you know, aftereffects.
Maybe in the long run it does,but people who normally smoke
(23:04):
marijuana will typically say, oh, I prefer marijuana to alcohol
because it doesn't have thehangover and doesn't have the
negative qualities that alcoholgives you.
In that context, how would you?
Speaker 3 (23:18):
you're saying this or
people say this no people say
this okay, yeah, yeah, okay goodyeah.
Speaker 2 (23:24):
So, uh, like a lot of
people will easily say that, oh
yeah, I made the switch fromalcohol to marijuana because I'm
more functional with marijuanaor, you know, it helps me, I
don't know go to sleep, or nextday I don't have a hangover in
in a drug.
In a scenario like this, wheremarijuana is so new, there isn't
(23:44):
that much of research studiesout there, or maybe there is, I
just don't know.
Um, if, like, how would youcharacterize a lurking addiction
with a drug like marijuana,where seemingly the after
effects are relatively mildcompared to alcohol?
Speaker 3 (24:04):
Well, in your
scenario you've got a person who
has now switched drugs becauseof the unpleasant downside of
alcohol.
Yes, right, now switched drugsbecause of the unpleasant
downside of alcohol.
Yes, right, the index drug wasalcohol and they switched to
something else because theydidn't like the side effects or
were seeking a more favorableside effect profile.
We could say it that way If wetalked about it as a
(24:26):
pharmacologic intervention intheir need for something right,
need to change their mood andtheir attitude.
That all by itself is a bit ofa red flag, right?
So I still want the feeling ofdisconnection and intoxication,
but the alcohol has gotten tothe point where it's causing at
(24:46):
least as much harm as it is, ordeferred harm, or the hangover
harm, uh, as the benefit.
So I'm looking for a new drug,as huey lewis said, one that
won't make me sick.
Remember that old song.
So, switching to marijuana, uh,but still trying to preserve
the intoxicating benefits ofsome sort of substance worth a
(25:07):
look by itself, right, that'salready a caution.
Marijuana does not itself haveafter effects, or hangover, um,
we know that, that's true, right.
We know that's true in episodicusers and we certainly know
it's true in in chronic users ofmarijuana decreased motivation,
decreased scholastic and andwork performance.
Uh, increased weight, worseninglipid, increased anxiety.
(25:32):
And that's just for theincidental user.
Right, that's not somebodywho's using a high concentration
liquid THC in vaporized form orthese other methods for
vaporizing the molecule andusually inhaling it, although
(25:53):
edibles can be quite potent too.
So there's a withdrawalsyndrome associated with
marijuana.
There is profound boredom andirritability in the withdrawal
of chronic users and, like Isaid before about my own first
use of fentanyl, if you switchto marijuana and find it's
(26:13):
relatively free from these sideeffects compared with alcohol,
what do you think most peopleare gonna do?
They're gonna use it.
We use it more often right, so afriend of mine used to say
marijuana is not addictive whenused on a daily basis okay oh,
(26:36):
bit of a tongue-in-cheek commentabout that and most people have
a net negative effect.
now that doesn't mean thatsomebody won't tell you that
marijuana saved his life andthat it was great for his malady
or ailment or reason, and allthose anecdotes are probably
(26:57):
useful.
And there's good research andthe times have changed and
they're starting to look at thecannabinoid family as maybe
beneficial for all kinds ofthings.
We know it's for spasms andseizures, but other things as
well, and anti-inflammatoryproperties of some of the other
cannabinoids that aren't Deltanine.
But yeah, just have to behonest with yourself.
(27:20):
If you're excited that youdon't have to drink three
martinis at lunch, that you canpop, pop a gummy or or, you know
, have a few hits on your, onyour weed pen.
Speaker 2 (27:32):
Yeah.
Speaker 3 (27:33):
Let's be honest with
what you're getting from that
which is to be in two places atone time right here and not here
and what it costs you, becausenot being fully present in your
own life is ultimately expensive.
It ultimately is much moreexpensive than the discomfort of
(27:54):
being here.
Speaker 2 (27:57):
That's a very
interesting analogy.
I also want to talk a littlebit about.
You said that you know, duringresidency things were kept at
bay.
It's only when you became anattending and you had access to
this, and then eventuallythrough your director, did your
eventual path to recoveryactually start.
(28:19):
Um, but for lack of a betterterm, it sounds like right
throughout your career you werea high functioning addict and
you know yeah.
Speaker 3 (28:36):
I was super high
functioning usually, and I was,
and I, I was addicted to my work, for sure okay just by itself.
I couldn't.
I couldn't wait to get back tothe hospital.
I loved what I was doing.
I was completely immersed in it.
It was a very interesting timein anesthesia training.
(28:56):
There were some anticipatedchanges at the federal level
about how medicine was going tobe constructed.
This is during the second BillClinton administration.
That's how old I am.
Administration, that's how oldI am.
(29:19):
The specialties, especiallypanicked, thinking that they
wouldn't exist anymore, that itwould all be socialized medicine
, and, as a consequence, theprivate groups stopped hiring
new graduates and, as aconsequence, people were in
specialty residencies plasticsurgery and cardiac surgery and
anesthesia and others anddropped out, thinking there was
(29:41):
not going to work for themanyway.
And so that's part of why I wasrecruited out of surgery is
they needed people to do the joband they didn't have enough,
and so we worked like sled dogsdoing cases.
This is also before all thehours restrictions and hours
limitations that came laterafter the Zion case in New York.
(30:01):
So you know, 120 hours a weekwas a standard week, and when
you work that much and whenyou're that into it and there's
this constant parade of stuff,I'm not saying that I was busy
and I was working like 45, 50hours a week and so I didn't
have time to drink.
I'm saying if I was awake I wasprobably at work.
Speaker 2 (30:22):
Right, right.
It was like that.
Speaker 3 (30:26):
So that's you know,
workaholism, I'm sure.
I'm sure that qualifies interms of right.
You're supposed to work 40hours a week.
I was working essentially threecontiguous consecutive
full-time jobs of life and death, trauma hospital.
Speaker 2 (30:39):
Right.
Speaker 3 (30:40):
So not only no time
to use, but I had substituted
and this is looking back, it's agreat question I had I was full
, there was really no time toworry about myself or think
about myself.
Right, it was just doing thenext case, floating the next one
, putting the next chest togoing on the roof and meeting
(31:01):
the helicopter for the.
You know it's just right.
So it was very boom, boom, boom.
So you could say that I wasfunctioning, but I was.
In this case, I was highlyrewarded for being addicted to
work right In terms of increasedopportunities, rewarded in
terms of they're so short-handed.
(31:23):
You might find yourself doing avery complicated case as a
senior resident, really byyourself, and that happened to
me routinely.
So no time to do anything andalso no drive to do anything.
So, yes, it was dormant, it wasthere, but it's not like in
(31:47):
between.
My whole use period didn't lastvery long because it was mostly
not using.
It was this space in betweenusings or uses, and then, when
it got to where everything cameoff the rails, I was like, you
know, a few weeks.
Fentanyl is a very wicked horseto ride.
(32:09):
It wears off so quickly.
Okay, dose frequency gets youto, gets you in trouble very
quickly.
So it's not like it's not likeI was managing for a long time
and getting by and like thecharacter on house you know,
having a few making some roundsand then having a couple.
(32:29):
It was not like that at all.
Right, it was work or sleep, andthen when I got a little bit of
a like that at all, right, itwas work or sleep.
And then when I got a littlebit of a break, that's when.
That's when this problem tookoff.
But uh, it came to light veryquickly, fortunately.
Speaker 2 (32:40):
Okay, um would you
say that people who tend to get
into, say, residencies,generally because of the
pressure and the stress, have anincreased propensity to use
drugs or have developed somesort of an addiction because of
(33:02):
the high levels of pressurerelated to any residency?
What would your thoughts be onthat?
Speaker 3 (33:09):
um, well, hmm, I
think that's.
I don't know, maybe that's true.
I think that it takes a certainkind of personality to do this
job, to sign up for being adoctor.
It's not easy and there'snearly always something else
(33:32):
internal, there's some otherinternal drive that if that's
channeled in a healthy way, itturns into a happy person doing
a great job.
But sometimes people arelooking for identity or
validation in their work or intheir activities, and there's
(33:56):
only so much that your job cangive you.
There's only so much.
So, um, we know that, um, weknow that some um so lifetime
prevalence this is this is likea statistics of addiction
Lifetime prevalence is the samewhether you're a physician or
not a physician.
So overall it doesn't make anydifference.
(34:20):
The forklift drivers and theactors in Hollywood and the
airline pilots they all have thesame lifetime prevalence of
substance use disorder, which isprobably around one in six or
maybe one in five.
But the time that it appearsfor physicians is earlier, and
(34:46):
so I'm not sure which is thechicken and which is the egg.
Is it that they're an enhancedpopulation?
That's probably not true,because overall, lifetime
prevalence is the same by thetime you get to the end of your
life as a physician.
Your chances of havingdeveloped a substance use
disorder are the same Forcertain specialties and certain
(35:07):
groups.
So for general surgeons it'sabout the same.
For male general surgeons it'sthe same.
For male general surgeons it'sthe same.
For female general surgeonsit's quite a bit higher.
So for male general surgeons,lifetime prevalence is about 16%
of substance use, includingalcohol use disorder.
For women in surgery it's 26%.
(35:28):
So is that because the womenattracted to surgery are more
likely to have substance usedisorders?
Probably not.
It's probably the job and it'sprobably what the job asks of
you, and it's probably thedivergence between you know, uh,
the notion of having it all andreally what that looks like on
(35:50):
a practical basis.
I think that causes people towant to soothe their feelings.
So the question is are drugaddicts or alcoholics attracted
to medicine?
I don't think so, particularlyIf you look at first responders.
They have the same profile.
(36:10):
They get in trouble early.
If they're going to get introuble because maybe the
pressure, maybe the isolation,maybe the you know, yeah,
there's, there's, there'ssomething we don't talk about
very much in our, in our inmedicine called moral injury.
You've heard that term before.
No first time Moral injury is isthe things that we are exposed
(36:32):
to and the things that we dothat hurt our essence or hurt
our souls as human beings.
So there's some stuff thatyou're called upon to do Burn
patients, trauma patients,pediatric patients, end of life
issues, end of life issues,people that look just like
(36:53):
family members or close to youin age, or all sorts of stuff
that our exposure to morbidityand mortality far outpaces the
non-doctors, non-physicians, andso sometimes that leaves a mark
(37:15):
and we're not very good attalking about it.
We're not very dang man.
You know that kid we brought inlast night that was in the car
crash.
She is the same age as mydaughter, where we just we don't
do that because we just don'tbuild it that way.
We're busy.
We're on to the next case.
Your work is work and you're notsupposed to have feelings and
those things accumulate and Ithink they're a um, I think
(37:39):
they're a big part of alcoholuse disorder in in and probably
substance use disorder.
Alcohol is still number one forfor all doctors, including
anesthesiologists, it's still.
It's still number one.
Drugs are distant number twoand um, because of the social,
you know, acceptance andavailability and so forth.
Alcohol is alcohol, right, but,yeah, we so we're.
(38:01):
We're not very good at dealingwith our, at healing ourselves.
We're not very good at um,discharging those feelings with
a lot of reasons right, losingour authority or seeming weak or
, uh, maybe it touches somethingelse we don't really want to
get into or aware of that we canget into.
So I certainly experienced that.
Um, anyone, anyone doing anykind of medicine, I mean any of
(38:24):
it, it can even.
It can even be, you know, whatseems like a relatively safe
specialty, like radiology ordermatology, these things.
These things come up and itdoesn't have to be trauma
surgery or transplant surgery orburn surgery, the stuff that I
was doing, so neuro.
So, anyhow, yes, work is hardand doctors are lousy at
(38:48):
treating themselves or openingthemselves up for treatment.
Speaker 2 (38:52):
Right.
So you know, now switchinggears to your recovery period,
and you mentioned that duringyour recovery period you
basically got called for aquote-unquote audit by her
director, and that was thebeginning of your journey to
recovery.
Looking back, do you think youwould have done things any
(39:17):
differently?
Would you would your journey torecovery, would it have been
different from the way you, thanwhat you have experienced?
Speaker 3 (39:28):
Different.
In case of what, what wouldhave?
Speaker 2 (39:31):
happened, the
initiation, the time frame would
you have?
Speaker 3 (39:37):
seen that.
Oh well, yes, probably,probably.
Besides Lou Gehrig, I'm theluckiest man on the face of the
Earth, because the substancethat I was using gets so bad so
quickly that it telescopes thetime from fun to problems, right
(39:57):
, so it just collapses it.
There's, there's, there's no.
Um, am I anyway there?
There would there have been nosmoldering use pattern?
There wouldn't have been.
I wouldn't have the ability tomaintain this occasional
recreational use of fentanyl.
Let's say We'll call it thatright, which sounds ghastly, but
(40:19):
there's no, I wouldn't havebeen able to do that.
There's no way.
Coaster, that went so quicklythat I was able to come to the
attention of people who wereinterested in my health much
more than I was, and also I wasin a specialty where it's a bit
(40:45):
of an occupational hazard, sothey had seen this before.
In fact I learned that before I,before, I think, before I got
to the hospital, I think I wasstill at the, at the you know
the clinical year, thepreclinical years.
In the classroom there had beenan anesthesiologist who was
found dead in the stairway, who,you know, popped out, injected
(41:07):
himself with fentanyl.
Who popped out, injectedhimself with fentanyl, quit
breathing and was found dead.
So this was one of the thingsthat was on the chairman's.
He was chairman then, so it wasone of the things that was on
his mind and so that doctor'sdeath probably helped save my
(41:27):
life because it raised theirawareness, raised their
attention Right.
So I was extremely lucky and Iwas also very lucky that the
substance itself is, you know,unless you die or get some sort
of infection from using it, it'svery benign.
It's's very, very gentle on thebody.
(41:48):
So I didn't develop cirrhosisor get cardiomyopathy in my 40s
or, you know, brain injury fromsubdural hematoma, from falling,
from being drunk okay it'sbecause things got so bad so
quickly and yet didn't kill methat I got.
you know, I got sober when I was29.
(42:09):
Okay it's, um, it's a big deal.
And so, yes, I've beenenormously lucky, did not feel
that way on that day.
On that day, I did not feellucky.
Speaker 2 (42:21):
Right.
Speaker 3 (42:22):
I felt like the you
know, the earth had just opened
up beneath me because all ofthis was gone and my, my
chairman to his credit, he's aphenomenal man said um, we've
been through this before we.
We expect you to get.
Well, you're going to go awayto a program and when they say
you're ready, you're going tocome back here and we love you
(42:44):
and we want you to come back andbe an anesthesiologist on the
faculty.
That's what he said.
Now, I didn't believe himbecause I thought he was just
saying that I don't know, so Iwouldn't flip out or something.
But it worked out exactly thatway.
Worked out exactly.
And so I'm living proof that ifyou quit following so I'm
(43:08):
living proof that if you quitfollowing your own plan and
follow the healthy, successfulplan as laid out, you can have.
You know it's been 25 years now.
My whole career has turned intotrying to help people with the
same problem.
We've talked about that a lottoday.
(43:30):
But I think you know you don'thave to.
Your endocrinologist does nothave to have diabetes in order
to be a good endocrinologist andhelp you manage your blood
sugar.
And theoretically that shouldbe true in this specialty also,
because if you understand themalady and you know the signs
and you know the medications andthe interventions.
You ought to be able to be andthere are many excellent
addiction medicine doctors whodid not have to go through what
I went through right, butthere's a special connection
(43:52):
with the patients when theylearn a bit of my story right
and I think, mostly becausethere's no judgment, they know
that I'm not, I don't, I don'tthink them any any as failures.
In fact I'm optimistic for themthat they made it to treatment
just like I did, and thatsomehow comes across and it and
(44:16):
it helps.
You know, it really helps foran illness that is surrounded by
shame and social embarrassmentand stigma and right right, and
that's huge.
That's a huge problem withgetting help.
Most people don't say, hey, I'mfeeling, I'm feeling scared and
sad and lonely.
Most people don't raise theirhands with that right and you
(44:39):
know I'm drinking a bottle ofwine at night and it's getting
into two.
Most people don't sing out andask for help at that point.
Right, you're hoping that theycan get a hold of it.
They, they're hoping it passes,and it usually does not.
Speaker 2 (44:52):
Right.
So I have two questions to kindof close this out.
The first one is it seems likea support system you alluded to
this earlier in the conversationis very, very important.
What do you mean by a supportsystem In this situation?
(45:14):
It's obviously somebody yourdirector who identified the
problem and obviously gave you alot of assurances, and I'm sure
there was family and friendswho supported you through that
whole process.
So what kind of like?
Because you know I mean.
One thing I've heard fromstudents across the board is
studying medicine is relativelylonely.
(45:35):
It's a field that a lot ofpeople don't understand.
It's a field that needs a lotof time, commitment from an
education standpoint as well ashoning your craft kind of a
standpoint.
As you mentioned, 120 hours.
What kind of people would youlike in your side of the ring to
(45:57):
even not get into this sort ofsituation?
Or an addictive person?
Speaker 3 (46:04):
Sure, sure.
Well, listen, everyone,everyone, everyone has an
addictive personality.
It's not?
the substance Okay everyone hassomething, whether it's not the
substance okay, everyone hassomething.
Whether it's uh, there's some,there's some good ones, better
ones, like exercise and hobbiesand meaningful work.
Those are all good things, butwe've already talked about how
even the good things can betaken to extreme and turned
against their opposites.
(46:24):
So, um, it's a, it's a group ofpeople with whom you're honest
and who you talk about thingsgoing on in your life, even when
there's nothing going on inyour life.
Because it can't be a group ofpeople that when I have trouble,
I'll call them up or I'll sendthem a text, because you won't.
(46:46):
You have to already be in thehabit of saying you know, here's
what's going on with my day.
You're like, oh, that's great,here's what's going on with my
day, oh, good, cool.
And so that time there's not along amount of time between the
last time we tagged up in thisexample and when I really need
to talk about something that'sserious you find your thumb
(47:09):
automatically dialing the phoneor automatically sending a text
or reaching out in your group,your WhatsApp group or whatever,
so that you can say, hey,here's what's happening and to
lower the activation, energybarrier of connecting, and it's
not just you reaching out, it'syou being reached out towards.
So people are sharing their,their lives and their the
(47:32):
important things going on withyou, and you're sharing them
with them.
Now, if you're talking about,about sobriety and recovery,
it's helpful if that group isaligned for that common purpose.
So if you got a bunch of peoplewho went through this, that's
the basis of the of the selfhelp programs or mutual help
programs like AA.
Hey, we all went through this.
That's fine, but we don't wantto go through it again.
(47:53):
So we stay updated with eachother on what's happening in our
lives and you listen to thestories and you share your own.
That kind of thing is great,but that can be through your
religious affiliation or sportsor the buddies that you have at
the gym affiliation or sports orthe buddies that you have at
the gym.
It's some place, though, thatyou, that you can and that you
(48:15):
are honest.
It can be with colleagues atwork also, so long as you can
find them.
It doesn't have to be somebodywith special knowledge of this
problem or even specialknowledge of whatever problem
you have at hand.
So we have a couple of puppiesthat are are you know about,
about here, and so we're going.
We have a couple of puppiesthat are are uh, you know about,
about here, and so we're gonnahave a special problem of
training two dogs.
You know, my wife is busylearning these online courses to
(48:38):
so that we have these traineddogs.
We don't make the same mistakesas before.
There's a group of people,there's a dog trainer, a group
of other people with these dogbreeds.
There's a right so you can find.
There's a right so you can find.
If you're willing to be honest,you can find other human beings
on this journey to candidlyshare what's happening in your
(48:58):
life.
They don't even have to giveyou a solution, oftentimes just
hearing yourself say it well,you know, I'm thinking about
quitting my job and moving to.
I'm thinking about quitting myjob and moving to Curacao and
escaping the world.
And then you hear yourself saythat and you're like well,
actually, curacao is part of theworld and there's really
nowhere else to go, and what'sreally going on is my boss or my
(49:21):
whatever, whatever the actualsituation is, and you have a
chance to do something different.
So in my case, I already hadthat that support I was not
availing myself of.
This is way back then, rightback in the back in the 90s, I
was not availing myself of it.
I'm sure if I had said, ah, youknow I'm thinking about using
(49:44):
fentanyl and um, but I knowthat's not a good idea, at least
intellectually.
But I'm intensely curious aboutit.
What do you think about it,chairman?
I would have avoided thatentire right, that entire period
.
Few people have the courage todo that.
Right, right, right, right.
(50:05):
I certainly did not um, but youneed to grow that kind of
courage to deal with problemswhen they're when they're small
right, when they're when they'relittle, rather than let them
get out of hand.
Speaker 2 (50:16):
Right, well, that's
very interesting.
And the final question, drGiles, I have for you is for all
our listeners who areinterested in becoming doctors,
all our listeners who areinterested in becoming doctors
and, you know, considering thetime, not the constraints, but
the time commitments and thevolume of information that is
(50:36):
thrown their way what advicewould you have them have for
them as they are navigatingmedical school, or maybe even a
pre-med for all you know,pre-med medical school residency
fellowships.
What advice would you have forthem?
Speaker 3 (50:52):
um, well, there's
there, I guess there's there's
what you think it's like, andthen what it turns out to be
actually like, uh, the closeryou can get to.
So this is what I would say thecloser you can get to some good
, solid information on what it'sactually like, the better.
It's not like the shows ontelevision, and it's not.
(51:17):
It's not like, no, the movies,and it's not.
It's not like that at all.
It's way better and way worse,in both sense right.
And so the best advice is if youcould get at least one or two
good ones, and as many as youcan, if you can collect these
(51:40):
informational interviews andspend time with the physicians
and find out what their livesare like.
Find out what it's like to be anephrologist.
Find out what it's like to workin a pediatric clinic.
Find out what it's like to be apathologist.
I didn't know about any of thespecialties, really just one or
two before I started medicalschool, so I wouldn't have known
(52:02):
to go to all these differentpeople.
But the practical, day-to-daywhat it's like, right, what it's
like going to the hospital, orwhat it's like going to the
clinic, or what it's like beinga cruise ship doctor, that's
where your heart lies.
Right, that's what you want todo.
Go talk to them.
Go buy a doc a cup of coffee,or ask if you can sit with him
(52:24):
while he has a sandwich, or sitwith her while she's on her
break.
And sometimes the talking canbe done now by video, so you
don't have to, you know, to gothere as much as before, or it's
telephone call or text, textchat, but find out what, what,
what it's really like, becausewe just had match day right the
other day and people apply forjobs.
(52:44):
They go.
They go sometimes on these, uh,sub eyes or they'll.
They'll go on, you know, on onsite and do a bit of the job,
but they, you know you reallywant to talk to people who are
doing it.
You're not.
You're not getting a job as atrainee, you're pursuing a
career in that specialty.
So talk to the people who areout the back end of it.
Talk to the anesthesiologist.
(53:05):
What's your day like?
Are you happy?
Uh, what's?
What's the bad?
What Are you happy?
What's the bad?
What are the sucky parts?
What's the scut work in yourjob?
What's the best part of yourjob?
Treat it like this is hard forthe medical students and the
pre-meds to get sometimes.
But you're the prize.
You're the prize, not the job.
(53:27):
The job needs you more than youneed the job, right?
So where do you wanna spendyour time and attention?
Where does your?
What fires you up?
What's the best use of yourworking, productive life?
And if your applicants arecurious enough about themselves
(53:47):
to dig into that, then it'ssometimes you have to just go do
the job.
You don't know, right,sometimes you gotta.
You have to go be a whateveryou have to.
You have to do pediatrics tolearn.
You hate pediatrics.
Or you have to do obstetrics tolearn.
You don't want to be anobstetrician, but along the
pathway, and that happenssometimes.
But if you give yourself achance to get as much
(54:10):
information from the staff rightfrom the faculty, from the
attendings, from the people inprivate practice, you're
probably gonna end up in privatepractice, right?
Unless there's some specialties.
But you're probably gonna endup in private practice.
Go talk to the cardiologist ifthat's what you're thinking you
wanna do.
Go talk to the generalinternist if that's what you're
thinking you want to do.
Go talk to the generalinternist if that's what you're
thinking, and and listen as muchemotionally as intellectually.
(54:31):
I mean salary matters and jobopportunities matter.
But you know we're understaffedfor physicians in this country
by something, something like youknow 50 000 physicians
understaffed.
So you're not going to havetrouble getting a job.
You're, you're, you're job,you're going to be employed.
The question is what do youwant to spend your life on?
Do you want to spend yourcareer, at least the early part
(54:55):
of it, doing this particularspecialty?
It's worth the time and energyto figure it out.
Speaker 2 (55:01):
Thank you so much, dr
Giles.
It was such a pleasure hearingabout your journey and really
understanding some copingmechanisms that you had to think
of as you were going throughyour residency process, and I
think that this is a very, veryimportant time when we're
(55:22):
talking about what our newresidents really go through,
especially with MATCH havingbeen completed last week.
So, but thank you once again,really really appreciate it.
If you enjoyed this podcast orthe contents of it, please
download some more episodes fromour from Med School Minutes at
(55:43):
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Again, give us a like, give usa follow, if you like our
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It goes a long way for me andthe production team, and always
remember there is no shortcut tobecoming an MD.
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