𝒜𝓏𝒶𝑒𝓁 𝐻𝒶𝓏𝑒𝓁

pov: jack abbott and michael robonavitch are first year residents who fuck on the dl

Hi Pitt fans, I am writing this because I've seen several posts that make me very sad regarding what 'should have happened' to Dr. Langdon after he was caught diverting and using medications. It's going to get long so first my potential biases and then key points:

Potential biases: I am a registered nurse and I have a family member that has overcome substance use disorder which may lead me to disproportionately favor healthcare workers and addicts seeking treatment.

Key Points:

Addiction/Substance Use Disorder is a mental illness that requires the same compassion as depression or schizophrenia.

Addiction and drug diversion are a dangerous challenge that healthcare workers and organizations face. We go through training to spot impaired coworkers and how to respond(surprisingly, the Pitt did not handle that one as well as they handle other medical cases).

Restorative justice is proven to be more effective at preventing recurrence of a crime than punitive justice.

Healthcare workers who are found to be abusing and/or diverting medications are held accountable for their actions. They lose their ability to prescribe and dispense those medications for a period of time determined by their accreditation board, not the hospital.

Okay, so we are going to start way back in the 90s(So long ago that there were dinosaurs called paper charts and med dispensing logs that were hand written. These were easily deceived.) A group called the Institute of Medicine(IOM) published the first ever audit of medical errors titled To Err Is Human: Building a Safer Health System. In it, they reported that between 44k and 98k hospital deaths were a result of preventable medical errors. You may ask, "Squirrel, wtf does professionals screwing up and killing people have to do with letting druggies go back to treating patients in a hospital?" Well, I will tell you. People make mistakes. Dr. Langdon's descent into addiction was very realistic. He had an injury. He was prescribed medications to help him recover from that injury. He became dependent on those medications. He escalated as he developed a tolerance and his body needed more to achieve the same effect. It was very realistic.

Now, how does this tie into the bigger picture of medical errors?

Following To Err is Human being published there were multiple studies and plans and gathering of minds all intended to figure out how to fix this. People make mistakes. It's inevitable. A person cannot operate with 100% accuracy every day to provide flawless medical care. Mistakes will happen and, as a result of the nature of the mistake, people will get hurt. So the solution was to modify the systems that the errors were occurring in to stop those errors from reaching the patient. This is when electronic medical records became a requirement instead of a fancy gizmo, when patients got barcodes on their armbands, and nurses had to scan medications before giving them. Blood transfusions required dual sign-offs between two qualified providers. Time outs and checks were mandated prior to surgeries so doctors weren't removing the wrong organ or limb. Controlled substances required two qualified providers to 'waste' excess that wouldn't be given to the patient(Sometimes a doctor orders 1 mg of something and it only comes in vials of 2 mg for example. I need a witness to attest to me throwing out that unused 1 mg.)

Again you may ask, "Squirrel, why can the druggies go back to work though? They should get in trouble! They should be fired!" My answer? Human nature. See in order to modify a system to prevent a mistake, we have to know that the mistake has occurred, which means someone has to report that mistake. So, how do you feel about being a narc? Could you turn your coworker in if you knew that they would be fired with hundreds of thousands of dollars in debt? When they're married? When they have kids? Could you turn yourself in if you woke up one day and didn't recognize yourself in the mirror anymore? When you knew you had a problem and knew that you were going to lose everything? If you could, then you have a lot of integrity and courage. Not everyone does. So the system has to account for that. Not for what should be, or how you want it to be. The system must work with what is. Now, we hold people who divert medications accountable for their actions but they get a chance(1) before they're thrown out. They get to attend rehab. They get to attend meetings. They get random drug screenings for a looooong time and they cannot prescribe or dispense controlled substances. Doctors have to get other doctors to write those prescriptions and nurses have to find another nurse to pull, scan, and administer that medication to their patient. They are held accountable. They get to keep their community which is essential to substance abuse recovery and relapse prevention. The hospital does not lose otherwise capable providers to a treatable illness.

It's not perfect, but no system is. It is SCIENTIFICALLY proven to be more effective at treating addiction than punitive measures alone.

Frank Langdon deserves a genuine shot at overcoming his addiction and he is now going through a gauntlet. He is back in a high stress environment. He's already had one back injury and he works in a trauma bay so he's at high risk for another only this time he can't take anything stronger than Tylenol. He's surrounded by people who are waiting for him to screw it all up. He did screw up already so he knows failure is a possibility, but he still turned up. He needs people in his corner. If he'd come back all arrogant and sure of himself then I'd question it. However, he is behaving like a humbled man who wants a chance.

Last small point: Dr. Santos does not have to like Dr. Langdon. She should still treat him with respect. She doesn't have to accept his apology but she should not hit him with ultimatums that imply she may be willing to tell everyone that he diverted meds.

Dr. Langdon was right to apologize to Dr. Santos, but he has to accept her refusal of his apology. He does not have to air his dirty laundry to the ED. No one needs to know that Langdon has a substance abuse problem. All they need to know is that he was away and now he's back.

Some research and sources linked below for anyone curious about learning more:

Prior studies on addiction showed isolated animals in metal cages choosing drugs like cocaine or morphine uncontrollably until they overdosed. A later study modified the conditions of the experiment to better mimic a healthy natural environment for the test subjects(rats). It showed that most rats will disregard the drugs in favor of other rats, food, and play. The result suggests the importance of community and that people may turn to substances to fill a void that community and environment should occupy.