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Med School Minutes
Med School Minutes is where we discuss all things related to medical education. Provided by Saint James School of Medicine, this podcast tries to educate students on selecting and successfully completing a medical school. Our topics are fun and educational, and our hosts are knowledgeable and fun.
Med School Minutes
Med School Minutes - Ep. 51 | Addicted to Fentanyl, Saved by Medicine w/ Dr. Jason Giles
Addiction doesn’t discriminate - even in medicine.
Dr. Jason Giles was a successful physician, trained at top universities, and on track for a thriving career. But behind the scenes, he was battling a growing dependence on fentanyl, one that nearly derailed everything.
In this episode of Med School Minutes, he opens up about the moment things changed, how recovery reshaped his purpose, and why being high-functioning can also mean being high risk.
This isn’t just a story about addiction—it’s about honesty, second chances, and the power of medicine to heal both patients and doctors. 🤍🥼
Watch now and subscribe for more conversations that matter.
00:00 – Introduction & Dr. Giles Background
02:58 – How Addiction Quietly Took Hold
05:23 – The Turning Point
06:43 – Recovery & Finding Purpose in Addiction Medicine
10:23 – Writing His Story: Books & Lessons
18:42 – Warning Signs of Lurking Addiction
28:36 – High-Functioning but Struggling
36:42 – The Hidden Toll of Medical Training
50:51 – Final Advice to Aspiring Doctors
#MedSchoolMinutes #AddictionInMedicine #FentanylAwareness #DrJasonGiles #CaribbeanMedSchool #SJSM #SaintJamesSchoolofMedicine
Hello and welcome to another episode of the Med School Minutes podcast, where we discuss what it takes to attend and successfully complete a medical program. This show is brought to you by St James School of Medicine. Here is your host, Kaushik Guha.
Speaker 2:Thank you so much for joining us on another episode of Med School Minutes, where we talk about everything md related, with the focus on international students, specifically students from the caribbean. Today we have dr jason giles, who is an md board certified addictionologist, uh as our guest. He's going to about his journey and how he ended up where he is today as one of the country's leading addiction ologists. So, without further ado, let's welcome dr Jason Giles. Well, thank you so much, dr Giles, really appreciate you taking the time out of your busy schedule and talking to us a little bit about your career trajectory, and one thing I really want to start with I always start with is if you could give us a background about yourself.
Speaker 3:Sure, thanks for having me on your show. I appreciate it very much. And yeah, so I'm a medical doctor, I'm a, I'm a physician. I went to uh, I went to uc berkeley for college and then uc davis for medical school. Loved it, loved both.
Speaker 3:I had a hard time deciding between research and clinical medicine. Not so much I like I liked research. I was in an amazing lab at cal but clinical medicine not so much. I liked research. I was in an amazing lab at Cal but clinical medicine won and I was one of those.
Speaker 3:You may have some listeners that knew what they wanted to do when they first went in, but I was not one of them. So I loved everything. I loved when I was on pediatrics I wanted to be a pediatrician and when I was on internal medicine I was going to be an internal medicine doctor and so forth. It was all interesting to me. I started off in general surgery but wound up getting recruited into anesthesiology and I think that was mostly because of this interest in all sorts of things. You know, anesthesia is every kind of patient with every kind of medical problem having every kind of surgery, so that that three-dimensional mix of interesting patients, that that was fun to me and challenging and hard, and I liked it.
Speaker 3:Um, what I didn't know this is this this will play out later and what I wound up choosing to do for a career. But what I didn't know is I had a lurking substance use problem which would go away when I was busy with school, which was all the time. I mean all the time from college, all the way through. You have to get the grades and take the tests and so forth, so mostly that thing was under control. Through you have to get the grades and take the tests and and so forth. So mostly that thing was under control and by the time I got to some relatively easy rotations in anesthesia, I started and I don't have a great answer for this because it doesn't make any sense why somebody would do this but I got curious, probably the safest way or best way to say it. I got curious about the these substances and so I tried them and probably the worst thing that could possibly happen happened, which is nothing. Nothing bad happened.
Speaker 2:Okay.
Speaker 3:First time I tried it and when nothing bad happened, I thought well, okay, this is a useful tool for managing my feelings, for managing my boredom, for managing my boredom, for managing my yawning fear that I'm going to become a doctor out in the world soon and I'm not sure how to do this and I don't feel the normal things. They're normal that, standing with your toes over the diving board at the end of, at the end of training and about to go out into the world, it's normal to have second thoughts and to feel inadequate. I didn't realize that those were all normal thoughts and I wasn't asking anybody about them. I didn't say, hey, you ever feel like you know, you don't know anything and or can't really help anybody, which turns out to be quite common, really quite common, well, basically universal. Since then I've realized it's universal, but at the time I thought it was especially bad and I thought I wasted all this time and I was going to be a terrible doctor. And so to manage those feelings, I use these substances very rarely and then, very rarely, became, you know, not very often, and then not very often. Became not all the time, and then not all the time. Became well, not every day, and then not every day became well, not you know, all the time, every day. And so I was getting close to the point where I was going to start using these things at work. It was after work that I was using these chemicals that's part of my justification and fortunately I got a call from the chairman of the department, who had been unbeknownst to me, paying attention to the medications that were being signed out and I was AI would probably have picked this up a lot sooner. This is back in the late 20th century and so we had to rely on the pharmacists having paperwork and eventually going hey, this is like two times standard deviation for fentanyl use. And so I got a call from the chairman who said hey, we're not saying you did any of this, but we need all the medicine back in the pharmacy by six o'clock tonight. And I said can I talk to you? He said I was hoping you would say that, and that began the journey of recovery.
Speaker 3:So I went to recovery, dealt with myself as a patient rather than as a doctor, which is a completely different, totally different and learned a lot. Learned a lot about myself, learned a lot about myself, learned a lot about my family went back to anesthesia. I went back, finished my residency, worked as a cardiac anesthesiologist. That's what I've been training for. I had done a fellowship also in pain medicine in between there and that was interesting to me pain management. So I was doing both. I was doing cardiac anesthesia on call for heart heart surgery service in california and also opening a pain clinic super busy about five years sober.
Speaker 3:I got a call from an old friend of mine who had a treatment center in southern california and uh said hey, you know a lot about this stuff, can you come help us? I said, well, you know, I'm a little bit busy with this. He said, well, just check it out and see what you think. So I did. I thought, well, if I'm going to explore a new something else, and I liked it because it saved my life and I, um, I tried it out and it turns out it was the perfect job for me and I started working in the addiction treatment field and then I quick, you know, had to get formal training in that.
Speaker 3:So I got involved with the, with the board, uh, with the society that granted it and it's it's still a new specialty. There's just now fellowships in it and so forth. There's still no residencies yet in addiction medicine, but there will be someday. And so I had this experience and I had already been boarded in anesthesia and so I started doing addiction medicine full-time at this place in Southern California. And then, 20 years later, here I am still doing it. The only thing that's the only thing that's changed. I've done it consistently since 2005 and I have not gone back to anesthesia.
Speaker 3:The only thing that changed is five years ago we had all these lockdowns right because of all the virus fears and so forth, and so our specialty of addiction medicine went like this you know, videos and and interviews by telemedicine right and so I started, uh doing the same work, but doing it by telemedicine, and that's that's been enormously rewarding because reach more people, I have a much bigger team of folks that can help treat patients and I feel like you know anyone any one of your listeners who's in medicine, who's either in medical school or finished. It's an enormous privilege to be a doctor, enormous privilege, right? Just because just because you're a doctor doesn't mean you can't be a patient also and go through whatever you need to do to get well, whether that's your gallbladder or broken leg or substance use disorder. But the for most of us, for me for sure, it's a sense of calling or honor or duty to do this job and to help.
Speaker 3:For me, help as many people as possible, and with telemedicine and my experiences, my team and I get to help a lot, a lot more people. So I was, it was a fortune, fortunate, uh consequence of a bad time in the, in the world, in the country and in the world. And now, um, now we have many uh treatment facilities where we bring medical care, and excited about 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 a little bit of a background well.
Speaker 2:Thank you so much, dr giles. Would you uh quickly tell us about all the books that you've written about uh?
Speaker 3:yes, I wrote a couple. I wrote. I wrote a memoir, uh, memoir kind of. It's more than that, it's sort of a. I tried to cram everything in there. There's probably too much information in there, but it's a bit of that story that I told.
Speaker 3:It starts in the operating room with me promising myself that today I'm going to stop, which is a promise that I had made and broken many days in a row when I was dependent on fentanyl. But the back half of the book goes into practical solutions. You know, not everyone can get to a treatment center. In fact, 90% of people don't go to a treatment center. So, um, it's, uh, it's practical tips on on on drugs that you might be addicted to, or, um, problems that you might have, things that you should definitely 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, to make the story relatable. My intent is geez, if this guy can make it, then maybe anybody can. Right, doctors aren't immune. That was the primary intent. And then the other is well, I'm suffering, or my loved one is suffering, what do I do? So that's that book. And then the other book is it's called Outsmart your Addiction. Then the other book is is, um, it's called outsmart your addiction.
Speaker 3:The other one is uh, uh, the behavioral health tech manual, so that that's a? Uh kind of an inside baseball manual for the people that take care of the patients at the treatment facilities. They're the, they're the uh, they're the lowest, um, you know credential level person in the treatment centers and this is not well known. But unfortunately there's a big turnover. It's a tough job. It's a hard job. They don't have medical training. They're thrown into these positions where they're taking care of sometimes very sick people in withdrawal and because this is a bit of a catch 22, because they don't know what they're doing.
Speaker 3:Oftentimes they're newly sober themselves many cases you know, a year sober and they're like I want to give back and be in the field, but they don't understand the symptoms of withdrawal. They don't understand what's dangerous and what isn't, or how to report a medical. You know all the stuff that you learned in the first two weeks of medical school. They don't have any of that, or nursing school. So it was my idea that if we could help them learn how to be better at their job, then they would stick around, and so that's what that manual is about that just came out earlier this year. Okay, unless you're a behavioral health tech, it's probably not that helpful for you, but it's what to do when you don't know what to do. That's what that's about, and there's another one in the series coming out for nursing. That's going to be a bit more technical.
Speaker 2:Okay.
Speaker 3:But that's in part of the teaching mission. I think people need information, right, they need knowledge. So those are my two books so far Awesome, working on a couple others.
Speaker 2:Well, congratulations. Obviously, you've accomplished a lot, despite some initial hurdles in your career.
Speaker 3:Despite and maybe later. Because, right, because it's all. You never know what God's plan is and I would not have picked that for sure, right, I said I want 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. I had terrific people, had gone through it before me, I had lots of other physicians so I, I believed it was possible.
Speaker 3:Uh, and things just kept opening up. You know, the longer I kept at it, the longer I stayed healthy, the more the world opened up.
Speaker 2:Right. So I want to go back on a term that you used when you were introducing yourself, saying that when you were in med school, you had a lurking addiction.
Speaker 3:Yes.
Speaker 2:What does?
Speaker 3:that mean. That means that the relationship to the substances so drinking, for example, back in high school, was not exactly entirely, I'll say, healthy, not entirely healthy. I'll say healthy, not entirely healthy. You know, half of the country, half of the US, either doesn't drink at all or drinks less than once a month. That's about 50% of the country, so that's probably the most normal. There's another 25% of the country that occasionally will drink more than one drink and that number is two. So 75% of the country either doesn't drink at all or hardly drinks at all. 25% of the country has some sort of something more than that right. So averaging more than one drink a day puts you in alcohol use disorder category. It doesn't have to be every day. Use disorder category doesn't have to be every day, but drinking every day does, although some people have a glass of wine with dinner every day and they don't have a problem relationship to alcohol.
Speaker 3:And and so it's not that every, it's not that every time I interacted with just picking on alcohol, it's not that every time I interacted with it that I was always um, you know, drank to the point of excess or blacked out or any of that. In fact, that that I don't think ever happened, but probably the best way to say it is, I expected it to do more for me than than maybe others do and and I probably would have discovered this problem earlier if my life just weren't so packed and that there was no room for drinking. There was, there was, there was no room for drinking. So it's only it's only late in my training when I caught a little bit of a you know things. You start to get mastery over something. I had been there a couple of years, I'd gotten it. I was on a relatively easy rotation and then had this sense of you know, something's not right and this curiosity and also this probably special sense that I can handle this. I can handle this because of my training right, because I'll be careful that that kind of thing.
Speaker 3:Um, but looking back, so this is one of those things where if you had said to me, uh, in my, in my senior year of medical school, uh, or in my internship, uh, or maybe even in college, do you, do you think you've got a problem relationship to substances like alcohol? I would have said no. I would have said no. My friends and I, we drink sometimes, but mostly not because I'm busy with school and don't have time for it. That's why I would have answered the question. But on those occasions I was not in the first 75 percentile of people who take it or leave it no big deal that sort of stuff. If I was going to drink, it was with an unhealthy relationship to it.
Speaker 3:So I figured that out post hoc that this is a pattern that had been established for a while. So it's a good question. You know you ask people, do you have a problem? Then they may not. They may not know. You know I always I'm fond of saying well, you know, take a look, ask yourself the question, give yourself a chance to answer it privately, think about it for yourself. Do you have a problem relationship to alcohol or do you have a problem relationship to marijuana? That's another very common one and most people will tell you if they do or not, and I would not have been able to accurately answer that question until later. Oh, pattern started a long time ago. Oh, work and overwork is a is a way to deal with those feelings, right, it's a way to get validation. It's a way to be so busy that I right, it's a way to get validation. It's a way to be so busy that I don't have to worry about how I feel, if that makes sense.
Speaker 3:A lot of doctors fall into that pattern.
Speaker 2:I mean, you know, considering you just used some statistics about the United States, I mean USA a lot of people work long hours, they, you know, and I'd like to focus a little bit on the term recreational, like.
Speaker 3:Yeah, there you go, that's it. That's a slippery word, sure.
Speaker 2:Right and a lot of people say that, oh, I recreationally use marijuana or I recreationally drink. But it almost seems like the way you're describing it, as you mentioned, that this was a lurking addiction. Was that, even if this is not a regular occurrence, when you're indulging in it you're overindulging? Is that typically a sign for a lurking addiction?
Speaker 3:Yes, I would pay attention to that. Yes, binge drinking is the most common form of alcohol use disorder. So, even though the federal criteria or the ASAM criteria are this number of drinks per week or how often you're drinking, some people don't drink, don't drink very often, but when they drink, it's very excessively and so, yes, I would 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 a counselor and and I was explaining how I didn't really have a problem with this this is just this fentanyl thing got me like it gets some people. And he said, well, did you ever use? Do you ever drink? And I said, yeah, you know, I mean 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, what would that look like? And I explained, and it was definitely in the, in the, not every day, but definitely you would have to go wait a minute.
Speaker 3:In the context of what this eventually became, which was an opiate use disorder, is it, um, is it wiser or or uh. Safer to consider um or safer to consider that? Maybe this problem is as my son the economist would say what if substituted goods? Right, so alcohol is available, fentanyl is available, but the actual issue is the substance use disorder. And I said no, I would just drink around vacation, basically, or a day off. We had a long weekend off. Sometimes you get that in residency, but not not very often. And and he said Did you ever think that your drinking was ruining your vacation? And I had not.
Speaker 2:Interesting right.
Speaker 3:So vacation is time renewal and time of doing stuff you haven't got to, and relaxation and hanging out with friends and so forth. And the drinking muddies, all of that drinking the way I was drinking muddies all of that and that's what it is. That is, that you know we can save up and and not drink for extended stretches of time. In the early stages of this problem, people focus on the issues at the end, when you're compulsively consuming substances or compulsively gambling or compulsively doing whatever the other dependencies are. But there's this time.
Speaker 3:So a simple way to think of it is fun, fun with problems and then just problems. So I got to the latter stage stop being fun, but that middle period there where it's fun with problems, that's when that's so. That's the right answer to your question is if you're at home or if you're, you're at the gym listening to this podcast and you think, well, I mean, I don't drink that much, but when I do I drink the whole bottle of wine. It's worth a peek right. It's worth an honest conversation with yourself about your relationship.
Speaker 2:Right, that's how it is. So when it comes to other substances like, for example, let's take marijuana, this is a relatively new drug, newly legalized. Well, it's not officially legalized.
Speaker 3:Is it legal on the island of St James?
Speaker 2:St Vincent. Yes, it is actually. That's a huge economic driver actually in St Vincent and they've been giving out growing licenses. It's also a part of the culture also. It's they've been using it for centuries, but you know I mean.
Speaker 2:so we're headquartered in Illinois, in Chicago mm-hmm and Chicago it's like every block there seems to be a marijuana dispensary nowadays and this is a drug that it seems like has very little, you know, after effects. Maybe in the long run it does, but people who normally smoke marijuana will typically say, oh, I prefer marijuana to alcohol because it doesn't have the hangover and doesn't have the negative qualities that alcohol gives you. In that context, how would you?
Speaker 3:you're saying this or people say this no people say this okay, yeah, yeah, okay good yeah.
Speaker 2:So, uh, like a lot of people will easily say that, oh yeah, I made the switch from alcohol to marijuana because I'm more functional with marijuana or, you know, it helps me, I don't know go to sleep, or next day I don't have a hangover in in a drug. In a scenario like this, where marijuana is so new, there isn't that much of research studies out there, or maybe there is, I just don't know. Um, if, like, how would you characterize a lurking addiction with a drug like marijuana, where seemingly the after effects are relatively mild compared to alcohol?
Speaker 3:Well, in your scenario you've got a person who has now switched drugs because of the unpleasant downside of alcohol. Yes, right, now switched drugs because of the unpleasant downside of alcohol. Yes, right, the index drug was alcohol and they switched to something else because they didn't like the side effects or were seeking a more favorable side effect profile. We could say it that way If we talked about it as a pharmacologic intervention in their need for something right, need to change their mood and their attitude. That all by itself is a bit of a red flag, right? So I still want the feeling of disconnection and intoxication, but the alcohol has gotten to the point where it's causing at least as much harm as it is, or deferred 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 of some sort of substance worth a look by itself, right, that's already a caution.
Speaker 3:Marijuana does not itself have after effects, or hangover, um, we know that, that's true, right. We know that's true in episodic users and we certainly know it's true in in chronic users of marijuana decreased motivation, decreased scholastic and and work performance. Uh, increased weight, worsening lipid, increased anxiety. And that's just for the incidental user. Right, that's not somebody who's using a high concentration liquid THC in vaporized form or these other methods for vaporizing the molecule and usually inhaling it, although edibles can be quite potent too. So there's a withdrawal syndrome associated with marijuana. There is profound boredom and irritability in the withdrawal of chronic users and, like I said before about my own first use of fentanyl, if you switch to marijuana and find it's relatively free from these side effects compared with alcohol, what do you think most people are gonna do? They're gonna use it.
Speaker 3:We use it more often right, so a friend of mine used to say marijuana is not addictive when used on a daily basis okay oh, bit of a tongue-in-cheek comment about that and most people have a net negative effect.
Speaker 3:now that doesn't mean that somebody won't tell you that marijuana saved his life and that it was great for his malady or ailment or reason, and all those anecdotes are probably useful. And there's good research and the times have changed and they're starting to look at the cannabinoid family as maybe beneficial for all kinds of things. We know it's for spasms and seizures, but other things as well, and anti-inflammatory properties of some of the other cannabinoids that aren't Delta nine. But yeah, just have to be honest with yourself. If you're excited that you don't have to drink three martinis at lunch, that you can pop, pop a gummy or or, you know, have a few hits on your, on your weed pen.
Speaker 2:Yeah.
Speaker 3:Let's be honest with what you're getting from that which is to be in two places at one time right here and not here and what it costs you, because not being fully present in your own life is ultimately expensive. It ultimately is much more expensive than the discomfort of being here.
Speaker 2:That's a very interesting analogy. I also want to talk a little bit about. You said that you know, during residency things were kept at bay. It's only when you became an attending and you had access to this, and then eventually through your director, did your eventual path to recovery actually start. Um, but for lack of a better term, it sounds like right throughout your career you were a high functioning addict and you know yeah.
Speaker 3:I was super high functioning usually, and I was, and I, I was addicted to my work, for sure okay just by itself.
Speaker 3:I couldn't. I couldn't wait to get back to the hospital. I loved what I was doing. I was completely immersed in it. It was a very interesting time in anesthesia training.
Speaker 3:There were some anticipated changes at the federal level about how medicine was going to be constructed. This is during the second Bill Clinton administration. That's how old I am. Administration, that's how old I am.
Speaker 3:The specialties, especially panicked, thinking that they wouldn't exist anymore, that it would all be socialized medicine, and, as a consequence, the private groups stopped hiring new graduates and, as a consequence, people were in specialty residencies plastic surgery and cardiac surgery and anesthesia and others and dropped out, thinking there was not going to work for them anyway. And so that's part of why I was recruited out of surgery is they needed people to do the job and they didn't have enough, and so we worked like sled dogs doing cases. This is also before all the hours restrictions and hours limitations that came later after the Zion case in New York. So you know, 120 hours a week was a standard week, and when you work that much and when you'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, 50 hours a week and so I didn't have time to drink. I'm saying if I was awake I was probably at work.
Speaker 2:Right, right. It was like that.
Speaker 3:So that's you know, workaholism, I'm sure. I'm sure that qualifies in terms of right. You're supposed to work 40 hours a week. I was working essentially three contiguous consecutive full-time jobs of life and death, trauma hospital.
Speaker 2:Right.
Speaker 3:So not only no time to use, but I had substituted and this is looking back, it's a great question I had I was full, there was really no time to worry about myself or think about myself. Right, it was just doing the next case, floating the next one, putting the next chest to going on the roof and meeting the helicopter for the. You know it's just right. So it was very boom, boom, boom. So you could say that I was functioning, but I was. In this case, I was highly rewarded for being addicted to work right In terms of increased opportunities, rewarded in terms of they're so short-handed.
Speaker 3:You might find yourself doing a very complicated case as a senior resident, really by yourself, and that happened to me routinely. So no time to do anything and also no drive to do anything. So, yes, it was dormant, it was there, but it's not like in between. My whole use period didn't last very long because it was mostly not using. It was this space in between usings or uses, and then, when it got to where everything came off the rails, I was like, you know, a few weeks. Fentanyl is a very wicked horse to ride. It wears off so quickly. Okay, dose frequency gets you to, gets you in trouble very quickly. So it's not like it's not like I was managing for a long time and getting by and like the character on house you know, having a few making some rounds and then having a couple. It was not like that at all.
Speaker 3:Right, it was work or sleep, and then when I got a little bit of a like that at all, right, it was work or sleep. And then when I got a little bit of a break, that's when. That's when this problem took off. But uh, it came to light very quickly, fortunately.
Speaker 2:Okay, um would you say that people who tend to get into, say, residencies, generally because of the pressure and the stress, have an increased propensity to use drugs or have developed some sort of an addiction because of the high levels of pressure related to any residency? What would your thoughts be on that?
Speaker 3:um, well, hmm, I think that's. I don't know, maybe that's true. I think that it takes a certain kind of personality to do this job, to sign up for being a doctor. It's not easy and there's nearly always something else internal, there's some other internal drive that if that's channeled in a healthy way, it turns into a happy person doing a great job. But sometimes people are looking for identity or validation in their work or in their activities, and there's only so much that your job can give you. There's only so much. So, um, we know that, um, we know that some um so lifetime prevalence this is this is like a statistics of addiction Lifetime prevalence is the same whether you're a physician or not a physician.
Speaker 3:So overall it doesn't make any difference. The forklift drivers and the actors in Hollywood and the airline pilots they all have the same lifetime prevalence of substance use disorder, which is probably around one in six or maybe one in five. But the time that it appears for physicians is earlier, and so I'm not sure which is the chicken and which is the egg. Is it that they're an enhanced population? That's probably not true, because overall, lifetime prevalence is the same by the time you get to the end of your life as a physician. Your chances of having developed a substance use disorder are the same For certain specialties and certain groups. So for general surgeons it's about the same. For male general surgeons it's the same. For male general surgeons it's the same. For female general surgeons it's quite a bit higher. So for male general surgeons, lifetime prevalence is about 16% of substance use, including alcohol use disorder. For women in surgery it's 26%.
Speaker 3:So is that because the women attracted to surgery are more likely to have substance use disorders? Probably not. It's probably the job and it's probably what the job asks of you, and it's probably the divergence between you know, uh, the notion of having it all and really what that looks like on a practical basis. I think that causes people to want to soothe their feelings. So the question is are drug addicts or alcoholics attracted to medicine? I don't think so, particularly If you look at first responders. They have the same profile. They get in trouble early. If they're going to get in trouble because maybe the pressure, maybe the isolation, maybe the you know, yeah, there's, there's, there's something we don't talk about very much in our, in our in medicine called moral injury. You've heard that term before.
Speaker 3:No first time Moral injury is is the things that we are exposed to and the things that we do that hurt our essence or hurt our souls as human beings. So there's some stuff that you're called upon to do Burn patients, trauma patients, pediatric patients, end of life issues, end of life issues, people that look just like family members or close to you in age, or all sorts of stuff that our exposure to morbidity and mortality far outpaces the non-doctors, non-physicians, and so sometimes that leaves a mark and we're not very good at talking about it. We're not very dang man. You know that kid we brought in last night that was in the car crash. She is the same age as my daughter, where we just we don't do that because we just don't build it that way. We're busy. We're on to the next case.
Speaker 3:Your work is work and you're not supposed to have feelings and those things accumulate and I think they're a um, I think they're a big part of alcohol use disorder in in and probably substance use disorder. Alcohol is still number one for for all doctors, including anesthesiologists, it's still. It's still number one. Drugs are distant number two and um, because of the social, you know, acceptance and availability and so forth. Alcohol is alcohol, right, but, yeah, we so we're.
Speaker 3:We're not very good at dealing with our, at healing ourselves. We're not very good at um, discharging those feelings with a lot of reasons right, losing our authority or seeming weak or, uh, maybe it touches something else we don't really want to get into or aware of that we can get into. So I certainly experienced that. Um, anyone, anyone doing any kind of medicine, I mean any of it, it can even. It can even be, you know, what seems like a relatively safe specialty, like radiology or dermatology, these things. These things come up and it doesn't have to be trauma surgery or transplant surgery or burn surgery, the stuff that I was doing, so neuro. So, anyhow, yes, work is hard and doctors are lousy at treating themselves or opening themselves up for treatment.
Speaker 2:Right. So you know, now switching gears to your recovery period, and you mentioned that during your recovery period you basically got called for a quote-unquote audit by her director, and that was the beginning of your journey to recovery. Looking back, do you think you would have done things any differently? Would you would your journey to recovery, would it have been different from the way you, than what you have experienced?
Speaker 3:Different. In case of what, what would have?
Speaker 2:happened, the initiation, the time frame would you have?
Speaker 3:seen that. Oh well, yes, probably, probably. Besides Lou Gehrig, I'm the luckiest man on the face of the Earth, because the substance that I was using gets so bad so quickly that it telescopes the time from fun to problems, right, so it just collapses it. There's, there's, there's no. Um, am I anyway there? There would there have been no smoldering use pattern? There wouldn't have been. I wouldn't have the ability to maintain this occasional recreational use of fentanyl. Let's say We'll call it that right, which sounds ghastly, but there's no, I wouldn't have been able to do that. There's no way.
Speaker 3:Coaster, that went so quickly that I was able to come to the attention of people who were interested in my health much more than I was, and also I was in a specialty where it's a bit of an occupational hazard, so they had seen this before.
Speaker 3:In fact I learned that before I, before, I think, before I got to the hospital, I think I was still at the, at the you know the clinical year, the preclinical years. In the classroom there had been an anesthesiologist who was found dead in the stairway, who, you know, popped out, injected himself with fentanyl. Who popped out, injected himself with fentanyl, quit breathing and was found dead. So this was one of the things that was on the chairman's. He was chairman then, so it was one of the things that was on his mind and so that doctor's death probably helped save my life because it raised their awareness, raised their attention Right. So I was extremely lucky and I was also very lucky that the substance itself is, you know, unless you die or get some sort of infection from using it, it's very benign. It's's very, very gentle on the body. So I didn't develop cirrhosis or get cardiomyopathy in my 40s or, you know, brain injury from subdural hematoma, from falling, from being drunk okay it's because things got so bad so quickly and yet didn't kill me that I got.
Speaker 3:you know, I got sober when I was 29. Okay it's, um, it's a big deal. And so, yes, I've been enormously lucky, did not feel that way on that day. On that day, I did not feel lucky.
Speaker 2:Right.
Speaker 3:I felt like the you know, the earth had just opened up beneath me because all of this was gone and my, my chairman to his credit, he's a phenomenal man said um, we've been through this before we. We expect you to get. Well, you're going to go away to a program and when they say you're ready, you're going to come back here and we love you and we want you to come back and be an anesthesiologist on the faculty. That's what he said. Now, I didn't believe him because I thought he was just saying that I don't know, so I wouldn't flip out or something. But it worked out exactly that way. Worked out exactly. And so I'm living proof that if you quit following so I'm living proof that if you quit following your own plan and follow the healthy, successful plan as laid out, you can have.
Speaker 3:You know it's been 25 years now. My whole career has turned into trying to help people with the same problem. We've talked about that a lot today. But I think you know you don't have to. Your endocrinologist does not have to have diabetes in order to be a good endocrinologist and help you manage your blood sugar. And theoretically that should be true in this specialty also, because if you understand the malady and you know the signs and you know the medications and the interventions. You ought to be able to be and there are many excellent addiction medicine doctors who did not have to go through what I went through right, but there's a special connection with the patients when they learn a bit of my story right and I think, mostly because there's no judgment, they know that I'm not, I don't, I don't think them any any as failures.
Speaker 3:In fact I'm optimistic for them that they made it to treatment just like I did, and that somehow comes across and it and it helps. You know, it really helps for an illness that is surrounded by shame and social embarrassment and stigma and right right, and that's huge. That's a huge problem with getting help. Most people don't say, hey, I'm feeling, I'm feeling scared and sad and lonely.
Speaker 3:Most people don't raise their hands with that right and you know I'm drinking a bottle of wine at night and it's getting into two. Most people don't sing out and ask for help at that point. Right, you're hoping that they can get a hold of it. They, they're hoping it passes, and it usually does not.
Speaker 2:Right. So I have two questions to kind of close this out. The first one is it seems like a support system you alluded to this earlier in the conversation is very, very important. What do you mean by a support system In this situation? It's obviously somebody your director who identified the problem and obviously gave you a lot of assurances, and I'm sure there was family and friends who supported you through that whole process. So what kind of like? Because you know I mean. One thing I've heard from students across the board is studying medicine is relatively lonely. It's a field that a lot of people don't understand. It's a field that needs a lot of time, commitment from an education standpoint as well as honing your craft kind of a standpoint. As you mentioned, 120 hours. What kind of people would you like in your side of the ring to even not get into this sort of situation? Or an addictive person?
Speaker 3:Sure, sure. Well, listen, everyone, everyone, everyone has an addictive personality. It's not?
Speaker 3:the substance Okay everyone has something, whether it's not the substance okay, everyone has something. Whether it's uh, there's some, there's some good ones, better ones, like exercise and hobbies and meaningful work. Those are all good things, but we've already talked about how even the good things can be taken to extreme and turned against their opposites. So, um, it's a, it's a group of people with whom you're honest and who you talk about things going on in your life, even when there's nothing going on in your life. Because it can't be a group of people that when I have trouble, I'll call them up or I'll send them a text, because you won't. You have to already be in the habit 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 a long amount of time between the last time we tagged up in this example and when I really need to talk about something that's serious you find your thumb automatically dialing the phone or 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, energy barrier of connecting, and it's not just you reaching out, it's you being reached out towards. So people are sharing their, their lives and their the important things going on with you, and you're sharing them with them. Now, if you're talking about, about sobriety and recovery, it's helpful if that group is aligned for that common purpose. So if you got a bunch of people who went through this, that's the basis of the of the self help programs or mutual help programs like AA. Hey, we all went through this. That's fine, but we don't want to go through it again. So we stay updated with each other on what's happening in our lives and you listen to the stories and you share your own. That kind of thing is great, but that can be through your religious affiliation or sports or the buddies that you have at the gym affiliation or sports or the buddies that you have at the gym.
Speaker 3:It's some place, though, that you, that you can and that you are honest. It can be with colleagues at work also, so long as you can find them. It doesn't have to be somebody with special knowledge of this problem or even special knowledge of whatever problem you have at hand. So we have a couple of puppies that are are you know about, about here, and so we're going. We have a couple of puppies that are are uh, you know about, about here, and so we're gonna have a special problem of training two dogs. You know, my wife is busy learning these online courses to so that we have these trained dogs. We don't make the same mistakes as before. There's a group of people, there's a dog trainer, a group of other people with these dog breeds. There's a right so you can find. There's a right so you can find.
Speaker 3:If you're willing to be honest, you can find other human beings on this journey to candidly share what's happening in your life. They don't even have to give you 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 my job and moving to Curacao and escaping the world. And then you hear yourself say that and you're like well, actually, curacao is part of the world and there's really nowhere else to go, and what's really going on is my boss or my whatever, whatever the actual situation is, and you have a chance to do something different.
Speaker 3:So in my case, I already had that that support I was not availing myself of. This is way back then, right back in the back in the 90s, I was not availing myself of it. I'm sure if I had said, ah, you know I'm thinking about using fentanyl and um, but I know that's not a good idea, at least intellectually. But I'm intensely curious about it. What do you think about it, chairman? I would have avoided that entire right, that entire period. Few people have the courage to do that. Right, right, right, right. I certainly did not um, but you need to grow that kind of courage to deal with problems when they're when they're small right, when they're when they're little, rather than let them get out of hand.
Speaker 2:Right, well, that's very interesting. And the final question, dr Giles, I have for you is for all our listeners who are interested in becoming doctors, all our listeners who are interested in becoming doctors and, you know, considering the time, not the constraints, but the time commitments and the volume of information that is thrown their way what advice would you have them have for them as they are navigating medical school, or maybe even a pre-med for all you know, pre-med medical school residency fellowships. What advice would you have for them?
Speaker 3:um, well, there's there, I guess there's there's what you think it's like, and then what it turns out to be actually like, uh, the closer you can get to. So this is what I would say the closer you can get to some good, solid information on what it's actually like, the better. It's not like the shows on television, and it's not. 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.
Speaker 3:And so the best advice is if you could get at least one or two good ones, and as many as you can, if you can collect these informational interviews and spend time with the physicians and find out what their lives are like. Find out what it's like to be a nephrologist. Find out what it's like to work in a pediatric clinic. Find out what it's like to be a pathologist. I didn't know about any of the specialties, really just one or two before I started medical school, so I wouldn't have known to go to all these different people. But the practical, day-to-day what it's like, right, what it's like going to the hospital, or what it's like going to the clinic, or what it's like being a cruise ship doctor, that's where your heart lies. Right, that's what you want to do. Go talk to them. Go buy a doc a cup of coffee, or ask if you can sit with him while he has a sandwich, or sit with her while she's on her break. And sometimes the talking can be done now by video, so you don't have to, you know, to go there as much as before, or it's telephone call or text, text chat, but find out what, what, what it's really like, because we just had match day right the other day and people apply for jobs.
Speaker 3:They go. They go sometimes on these, uh, sub eyes or they'll. They'll go on, you know, on on site and do a bit of the job, but they, you know you really want to talk to people who are doing it. You're not. You're not getting a job as a trainee, you're pursuing a career in that specialty. So talk to the people who are out the back end of it. Talk to the anesthesiologist.
Speaker 3: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 your job? What's the best part of your job?
Speaker 3:Treat it like this is hard for the medical students and the pre-meds to get sometimes. But you're the prize. You're the prize, not the job. The job needs you more than you need the job, right? So where do you wanna spend your time and attention? Where does your? What fires you up? What's the best use of your working, productive life?
Speaker 3:And if your applicants are curious enough about themselves to dig into that, then it's sometimes you have to just go do the job. You don't know, right, sometimes you gotta. You have to go be a whatever you have to. You have to do pediatrics to learn. You hate pediatrics. Or you have to do obstetrics to learn. You don't want to be an obstetrician, but along the pathway, and that happens sometimes.
Speaker 3:But if you give yourself a chance to get as much information from the staff right from the faculty, from the attendings, from the people in private practice, you're probably gonna end up in private practice, right? Unless there's some specialties. But you're probably gonna end up in private practice. Go talk to the cardiologist if that's what you're thinking you wanna do. Go talk to the general internist if that's what you're thinking you want to do. Go talk to the general internist if that's what you're thinking, and and listen as much emotionally as intellectually. I mean salary matters and job opportunities matter. But you know we're understaffed for physicians in this country by something, something like you know 50 000 physicians understaffed. So you're not going to have trouble getting a job. You're, you're, you're job, you're going to be employed. The question is what do you want to spend your life on? Do you want to spend your career, at least the early part of it, doing this particular specialty? It's worth the time and energy to figure it out.
Speaker 2:Thank you so much, dr Giles. It was such a pleasure hearing about your journey and really understanding some coping mechanisms that you had to think of as you were going through your residency process, and I think that this is a very, very important time when we're talking about what our new residents really go through, especially with MATCH having been completed last week. So, but thank you once again, really really appreciate it. If you enjoyed this podcast or the contents of it, please download some more episodes from our from Med School Minutes at any of your favorite platforms, such as Spotify, google or the Apple Store. Again, give us a like, give us a follow, if you like our content. It goes a long way for me and the production team, and always remember there is no shortcut to becoming an MD.
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