Footnotes: Their Own Supply

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Published August 25, 2009

What’s not to love about a sardonic melodrama about medical professionals with severe barbiturate addiction? The tension is readymade: the high stakes nature of medicine; the unfettered access to drugs; the unquestioned authority of a junkie. So, it’s no wonder that Nurse Jackie, the season finale of which premiered last night and featured Edie Falco’s titular character graduating to varsity-level opiate Oxycodon, has been renewed for another season. Meanwhile, TV land’s favorite addled MD, Gregory House (Hugh Laurie), will be back for a fifth season in the fall.

Every time we see Jackie, a calloused but competent nurse, sneak away to take a hard snort off a pulverized line of pills, the transgression seems almost too disturbing to believe. But believe it.  An estimated 12 percent of medical professionals are substance abusers. Obviously, the affliction is under-reported, but the stories that do surface make for some pretty compelling drama themselves.

This week, a Virginia woman filed a $10 million lawsuit against her her longtime physician. The suit claims the doctor pressured her into a sexual relationship and then used her as an intermediary to obtain prescription drugs.

Another Virginia physician, John F. Pholeric Jr., who had cycled in and out of rehab for cocaine addiction, accidentally dislocated a patient’s jaw during surgery because he was high and was eventually convicted of a felony. There’s also the gastrologist who injected himself with painkillers intended for his patients. But none of these men lost their licenses. They were disciplined and enrolled in mandated rehabilitation but were still allowed to practice medicine.

“Medicine tolerates behavior that in any other industry would be unacceptable,” said Lucian Leape, a physician and Harvard professor of Public Health, told the Washington Post in 2004.  “There are patients’ lives at stake . . . and that’s more important than a doctor’s career.”

Unlike registered nurses, physicians have an insular network of clemency. So, were someone like Jackie were to get busted making recreational use of office supplies, she would most likely not receive the same leniency as a doctor like Gregory House, a self-medicating Vicodin addict who dabbles in methadone and self-identifies as a “big drinker”. There is, of course, an ideological ethos to the kid gloves approach: addiction being a disease instead of some kind of moral dereliction.

Because the lag time of the state-based machinery charged with monitoring and disciplining nurses and doctors for drug abuse is immense (you can read all about some naughty California nurses here), the de facto position on the matter of pill popping medical professionals like Jackie and House is fairly sympathetic. So, while House gets to check into a rehab clinic with the blessings of the hospital brass, Jackie may not be so lucky in the second season.