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The Other Crisis: Some Days I Am Not OK

 

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I’ve spoken to him once in the past six months and haven’t seen him in two years. But his presence is always felt, in the shadows of my day and in my deepest fears each night. Unless you have been there, it is so difficult to understand, so easy to judge, and so easy to ignore.

For those of us with loved ones suffering from addiction, we have no choice but to find ways to get through each day. Some of those days are easier than others.

On the hardest days, since I have the luxury of working from home, I can just turn off my camera and press on. It’s easier to project a fake voice than to hide the exhaustion on my face or the sadness in my eyes.

They say there is comfort in numbers, but I wish this on no one. 

Yet, millions more are like me.

According to the Substance Abuse and Mental Health Services Administration, more than 4 million Americans were identified with substance use disorder in 2018. About 2 million of those were related to opioid use, including pain relievers or heroin. Another million were related to methamphetamine.1

In the 12 months ending in May 2020, over 81,000 people died from overdose deaths in the United States, the highest 12-month number ever recorded.2

Many people suffering from addiction have people like me in their lives—the ones who don’t sleep at night, who get a literal pain in the stomach when the phone rings after a certain hour, who replay countless memories over and over to try to decipher how things went so horribly wrong.

We are also the people who need to pull it together day after day, not allowing the other pieces of our lives to be destroyed by the addiction.

We are everywhere; this enemy does not discriminate.

Many are on the front lines of healthcare: our doctors, nurses, lab techs, and environmental service workers. And they may already be experiencing burnout from the job itself and/or the current pandemic. Couple that with carrying this constant weight inside their chests and it can be a recipe for catastrophe. While humans are remarkable and often incredibly resilient, our capacity for chronic stress is not without bounds and eventually we can break.

When those breaking are our healthcare workers, patient safety is directly impacted.

Imagine for a minute getting a call from your 25-year-old son at 3 a.m. asking for gas money. Odd requests for money are common occurrences with people suffering from addiction. You decline and tell him to meet you at the local gas station later on your way to work and you will pay for a fill-up, full well knowing that he probably doesn’t need gas and won’t show.

Just in case, you pull into the gas station a few hours later and see his car parked there. As you’re walking up to the car, you notice him slumped back in the seat. You rush to the car not knowing if he’s dead or alive.

The car is locked, the windows are up. You pound on the windows, screaming his name. You feel like you could collapse right there in the parking lot. People are looking but no one comes to your side. Then he stirs a bit and looks at you like he is having a bad trip and you happen to be in it.

You deal with the situation and get him to a safe place. You still must go to work, because if you took time off every time this happened, you would have lost your job long ago.

This isn’t a fictional story. It is one that haunts me to this day. What if he had killed himself or someone else driving to that gas station (which I told him to do in my own frustration)? What if he had been dead in that driver’s seat because I didn’t take a different course of action at 3 a.m. when he called?

Life for people like me is always full of “what ifs”—and they sneak up on you. This event happened more than five years ago. I can go months without giving it a conscious thought but then it creeps in when I least expect it: when I’m driving down the highway, reading a book, or playing with my grandchildren—you just never know when it will be.

Now imagine being an ICU nurse or a surgeon and having to pull yourself together after an event like this (or worse) to perform surgery on another human being or manage critical intravenous cardiac medications, where one wrong programming of equipment or one wrong cut could result in someone’s death.

If you think this isn’t happening in your organization, with your colleagues—you are wrong.

When clinicians are under chronic stress, negative consequences follow. In an often-cited study of 6,695 physicians, it was concluded that physicians experiencing burnout and fatigue were more likely to report a recent medical error.3 Other studies show an association between well-being; burnout; and poor outcomes, including medical errors.4

While attention is given to burnout and fatigue, much of it only addresses contributing factors related to the job itself, like staffing, productivity goals, and shift work. These are incredibly important, but they are only one part of the problem for potentially millions of people. We need to tackle all causes of chronic stress, including those that we do not talk about.

How do we begin to address the personal stressor of addiction to minimize its negative impact on job performance and safety? Here are a few ideas.

  • Acknowledge that stress related to the drug crisis in this country is real and it crosses the workplace doors. Change the expectation about leaving troubles at the doorway. It just does not work that way. If we fail to engage in healthy strategies to cope with this stressor, it will rear itself as we go about our daily duties. 
  • Create a place where we are not ashamed or embarrassed to acknowledge the problem. If someone on your leadership team is facing this issue in their family, encourage them to share their story and support them. This helps release the stigma associated with this disease and creates a safe space for others. If they need additional encouragement, tell them to call me. 
  • Encourage and actively support employee well-being. This is not the same as employee wellness. Wellness is generally geared toward physical health like going to the gym and preventative medicine. Well-being is more holistic than that; it encompasses our emotional and mental health. And while responsibility for one’s own well-being is an individual one, organizations should provide the framework to support it. This includes mental health care, supportive management, and a safe environment.  
  • Evaluate the well-being of your employees and ask what is lacking. Resources are finite, so support needs to be effective. Lack of treatment centers for their loved ones is a very different need than providing space for in-person or virtual support groups for employees. 
  • Create a resource center on your organization’s intranet site that highlights local group and individual support. Even as people become comfortable discussing addiction, many may still want the privacy of online resources (as opposed to walking into the HR office and asking for information). 

 

Finally, remember that even though there are so many of us on this journey, we are all in different places—and sometimes that place changes daily.


​​Most importantly, be kind.


About this blog

Regina Hoffman serves as the  executive director of Pennsylvania’s Patient Safety Authority and editor-in-chief of Patient Safety, its award-winning journal.  Ms. Hoffman was recognized by Becker’s Hospital Review as one of the top 50 experts leading patient safety in both 2018 and 2020. This blog serves as a source for her to share her insights in patient safety and leadership with Pennsylvania’s healthcare leaders.

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Citations:

1. Substance Abuse and Mental Health Services Administration. Results From the 2018 National Survey on Drug Use and Health: Detailed Tables. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration website. https://www.samhsa.gov/data/. 2019. Accessed January 29, 2021. 

2. Centers for Disease Control and Prevention. Overdose Deaths Accelerating During COVID-19. CDC website. https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html. December 17, 2020. Accessed January 29, 2021. 3. Tawfik, D, et al. Physician Burnout, Well-Being, and Work Unit Safety Grades in Relationship to Reported Medical Errors. Mayo Clinic Proceedings. 2018; Volume 93, Issue 11. Pages 1571-1580

3. Tawfik, D, et al. Physician Burnout, Well-Being, and Work Unit Safety Grades in Relationship to Reported Medical Errors. Mayo Clinic Proceedings. 2018; Volume 93, Issue 11. Pages 1571-1580. 

4. Hall LH, Johnson J, Watt I, Tsipa A, O'Connor DB. Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review. PLoS One. 2016;11(7):e0159015. Published 2016 Jul 8. doi:10.1371/journal.pone.0159015


***​ The views and opinions expressed at or through this blog are the opinions of the author alone and may not reflect the opinions or positions of the Patient Safety Authority or the Commonwealth of Pennsylvania, nor do these views represent in any way medical or legal advice. ​ 


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