Episode 044: A Hard Pill to Swallow

Speaker 1: You are listening to Your Practice Made Perfect, support, protection and advice for practicing medical professionals brought to you by SVMIC.

Brian: Hello and welcome to this episode at SVMIC of our podcast. My name is Brian Fortenberry, and I'm very excited because we have a fantastic guest with us today. We have Dr. Lloyd here to talk about addiction and the Tennessee Medical Foundation, and all those issues surrounding that. Dr. Lloyd, thanks for being here.

Dr. Lloyd: Thank you for having me Brian.

Brian: Before we jump into talking about the specifics, tell us a little bit about yourself, and I guess you really can go ahead and start talking about your background. Let's start walking down the road of your life experience.

Dr. Lloyd: Professionally I'm an internal medicine physician by trade. I was born and raised in east Tennessee, little town called Jonesboro, and went to the University of Tennessee to undergraduate, and then did medical school and residency at East Tennessee State University. I was a chief resident my last year in residency there. From there I went on to be a faculty at East Tennessee State University's School of Oncology Medicine for ten years and followed that up by chief of medicine at the Mountain Home VA Medical Center before I took my current job.

So I'm an east Tennessee boy, grew up in just the very foothills of rural Appalachia, which is, most people are aware of is basically the buckle of the Oxycontin belt, the opioid crisis that we currently face. Interesting Brian, growing up, I never really had trouble with drugs. You know like anybody growing up in that area, a little marijuana here and there, that was the University of Tennessee-Knoxville in the 1980s, and the big thing in the '80s was cocaine.

That was the big drug, and when I was a sophomore at UT, I was a big sports fan. There was a basketball player from University of Maryland named Lenny Bias, so he was the second pick overall pick in my favorite team, the Celtics picked him. The night he got drafted, he snorted cocaine and died of a fatal arrhythmia.

Brian: That was a big story at the time too, it was enormous.

Dr. Lloyd: It was a huge story and apparently was the first time he ever used and all indications was, it was. I just remember anytime I was faced with cocaine through college, I never did. I always thought about that.

Brian: That was enough to steer you clear.

Dr. Lloyd: Oh yeah, absolutely. I kind of wonder where that went later in my life because opioids are way more deadly than cocaine. But it really did, so alcohol wise I was a binge drinker, I wasn't a daily drinker at all. But certainly a binge drinker, which is very common in college. But, I was able just to before I went to med school, I just lay that down. I never had any problem quitting, just I didn't wanna do this anymore, and I didn't.

Brian: So it didn't affect all your ability in academics in school or medical school or anything else then?

Dr. Lloyd: No, I never got in trouble with it. I had a couple of close incidences, mainly around sporting events like most people would. The '80s were a little different when it comes to things like that, but I guess now I would've probably gotten into trouble with things like public drunkenness, but it was a binge episodic thing. It was never daily, and I was never dependent on it. So I was able to lay it down. Matter of fact, I didn't drink a single drop of alcohol all through four years of med school. I just didn't at all, I had a young family, and to be honest with you, I was scared about being able to pass med school. I was a non-traditional student, and I was 27 years old and had two kids. The very first exam I failed, I made a 69 on it, I thought oh my gosh, I've quit my job, I've got two children here and it was funny because that really helped me. I went straight for help, instead of running, I ran to help and wound up doing very well in med school and residency.

My last year of residency at the VA in Johnson City, I was getting ready to step out into practice. It's a scary thing for a resident. We can complain all we want about, we didn't have work hour restrictions back then, so we were working all the time, but it was still a protected environment. We had attendings name on the bottom line.

Brian: When it started rolling downhill, it rolled on past you.

Dr. Lloyd: Oh absolutely, absolutely. So I was getting ready to step out of that protected environment into a job that I really wanted. I wanted to teach other doctors. I wanted to be a faculty member, I wanted to round in the hospital teaching residents and students. I had that job, I had the opportunity to do that. But it still felt like I had all this anxiety, and I felt like I had depression as well.

I was driving home from work one day, and I pulled up there in the red light on Market Street in Johnson City, right in front of Colonel Steve's Liquor Store. I reached over to my glove compartment and flipped the glove compartment open. I still don't what I was looking for, and there were some old narcos in there, Hydrocodone.

Brian: Okay.

Dr. Lloyd: That I had from a dental visit months before. You go to the dentist and they do a procedure, then they load you up with opioids, leave them because they don't want you to call back. I didn't take them, it didn't hurt. So I threw them in the glove compartment. I remember looking over there and seeing it and thinking, you know my patients take these things all the time.

So, I took one out of the package, it was a little sample and broke it in half. So that's two and a half milligrams of Hydrocodone. Threw it in my mouth and at the time, I was living out in Boone Creek. It was about ten minutes away, maybe. By the time I got home I felt like I'd found a cure for my anxiety and depression. It was really the most amazing thing, in just that short amount of time. Within three years I was using the equivalent of 500 milligrams of oxycodone a day.

Brian: Wow.

Dr. Lloyd: If you wanna put that in Hydrocodone terms, they're pretty similar and Vicodin, that'd be 100 Vicodin pills a day.

Brian: That's really dangerous. I mean it's a wonder you're even here, that's a tremendous amount of narcotics.

Dr. Lloyd: It really is and you know for the longest time, as it got towards the end, 'cause this all happened over about a three year time period, three and a half years. As I got towards the end, I was so scared to count, but I knew. I knew if I got a bottle of 90 in the morning, that it was gone by the end of the day. So I knew it was over 90. The feeling there is so helpless, and the things that happened is a thousand stories you look back on. Sometimes cringe and almost cry.  I'll tell you one in particular, I love coaching baseball. I'm a baseball guy.

Brian: I love baseball.

Dr. Lloyd: I ran into some kids I coached this past weekend, and they're all in professional baseball now. I've got one of my former players is a pitcher for the Detroit Tigers. So I had some really good players. My buddies told me I should have won more games.

But, we were playing in the state little league tournament in 2003. Nothing I would rather do than hang out with these little boys. We had so much fun. But I was addicted to pills. We're getting ready to play in the state finals against Lexington, Tennessee. State little league finals, Johnson City, we made it to the finals, and I had the best player in the state, Daniel.

I was out in the outfield messing around with the kids before the game, and I dropped my little pill carrier. The top of it came off and I realized as we were walking into the dugout that I didn't have them. So the kids are in there getting excited, we're getting ready to play in the state championship game, and I'm out in the outfield digging around through the grass looking for pills.

The kids don't know that, they know about me, I've been very open with this, but that's a moment that I haven't talked about very much that really impacts me a lot now looking back on it. Because, what a special time with those kids, we lost, we finished runner up mainly because I'm not a very good manager. Just think of how sad that was. I forgot about everything else at that moment, and you know it's one of the things that I've been on a quest for really the last 13 years to try to figure that out.

How does that happen, and I actually know how it happens. The reward center of our brain which is responsible for basically our drive to live is a part of our brain that's hijacked by opioids or any drugs as a matter of fact, but particularly opioids. So literally, if your cravings for these drugs are ten times stronger than a normal person's cravings are for food when they're hungry. So when you start to look at it in that perspective, if you don't have the drug, what will you do to get it.

Brian: And the answer's anything, right.

Dr. Lloyd: Absolutely, what would you do to live.

Brian: Right.

Dr. Lloyd: People who are starving on an island will self-cannibalize, they'll eat themselves, they'll eat the people with them. So your desire to live is really strong, and that's the same are of your brain that these drugs hijack. At that moment for me, my son was on that team. Those kids I'd played with I can't tell you how many hours.

The good thing for me was things come full circle. You know three years later I'd gotten help, and we made it back to the state finals and we won. It was a great moment, one because we won, but two because I wasn't out in the outfield searching for pills in the grass.

Brian: Right.

Dr. Lloyd: I say that flippantly, but it's the truth.

Brian: One thing that has already stuck with me that you said, was the appetite for the medication is ten times greater than the normal person's appetite for food. It's easy for us to always say, well this guy or lady missed this so important event for their child, or missed this or messed that up or gave up. I've been even guilty before of seeing superstars and athletes go, you've got everything you could possibly want in life. Why in the world would you waste it on that.

Well, that's my answer, whenever I hear you say the appetite for the medication is so great that nothing else truly matters at that moment.

Dr. Lloyd: The people that I love to treat now are IV drug dependent pregnant women. I mean it's the most fun I've ever had in medicine. I get people all the time say Steve you know, these women just need to put it down. They're hurting their children, their babies are born dependent or addicted and they just need to quit.

I've said, well thank you, your suggestion was very helpful. I didn't think of that. But that's a flippant answer that I don't give anymore, but I say, you know I agree with you. But, it'd be easier for you to stop eating. That's actually true, and I think about this all the time. We were talking before we got started here.

I grew up in rural Washington County, Tennessee.  As a little boy I can't imagine, if I look into my future and say what's your life gonna be like at 50 Steve? We just settle down, I couldn't imagine this life. I can't imagine the places I get to go, the restaurants I get to eat in, the cars I drive, the neighborhood I live in. As a little boy, beyond my wildest imagination.

Brian: Getting to sit here with me and talk.

Dr. Lloyd: Absolutely, right here at SVMIC, it doesn't get much higher than that. I couldn't fathom that, a kid like me coming where I came from graduating med school. Wow, I wouldn't have been able to dream it. But it didn't matter. Once I became dependent, once I became truly addicted, the only thing that mattered was that.

I used to get up every morning and at night I'd withdraw. I mean I'd wake up in a pool of sweat and I was in my mid well, 34, 35 years old, not an old guy at all.

Brian: Sure.

Dr. Lloyd: When I woke up in the morning, I felt like an 80 year old man. I'd go into my bathroom where I'd get dressed in the morning. I've got two pictures there of my kids, and at the time my wife had taken them, and she had my sons picture made into clothes that I wear to work and of course they're draped all over me.

She had my daughters picture made in a wedding dress that she married me in, and those are still my favorite pictures. I used to lay those pictures out on the counter and look at them in the morning and cry, 'cause I couldn't quit. I'd look down at those pictures and like look man, you're living a dream here, what is going on.

Then a handful of pills in my mouth or up my nose and out for another day. It's a pathetic, scary existence Brian. I lived it for about three and a half years.

Brian: You have the conflict as you stare at pictures of family and things that are just vitally important to you knowing that is my meaning in life, or what I want my life to mean. In my other hand, I'm holding a handful of pills, and this is what my brain has said now life is. It's all about this, and that personal conflict that you have, but the strength of the addiction is so bad, that when the moment to choose comes, you can put the pictures down and pick the pills up is just beyond my comprehension of understanding the demons that someone has to deal with there.
Dr. Lloyd: I can't say it any better than that, that's exactly the choice you're faced with. People will ask you, now what are your priorities in life. Particularly people involved in faith-based organizations. It'd usually be something like God, family and job you know.

Brian: Right.

Dr. Lloyd: I could write that down all day long, the truth was it was pills and pills was number one because I couldn't do anything else without those. The existence that you have, think about waking up every morning saying okay, I've gotta have a hundred pills today, how am I gonna get them.

The problem is, is that's 24/7, 365, talk about a drain right. My worst fear was going on vacation. If I'm gonna go on vacation, then my drug supply's at home. It's not in Orange Beach, Alabama where we go on vacation. So towards the end, this was just a few months before I was fortunate enough to get to go to treatment, we took off to Orange Beach, Alabama, and I actually had my hands on 700 pills, which is a lot. I thought okay, I can relax and have a good time at the beach and not have to worry about pills.

But like any good person with addiction, that's a lot of pills, so I took a few more today, and I won't take as many tomorrow, and the next thing I know I ran out on Thursday. So now you're faced with being with your family at the beach, should be having the time of your life and now you're gonna get dope sick.

So I was in south Alabama, and I was thinking well, I'm gonna be dope sick for three days if I don't do something. I thought surely I can find a pill mill, we're in south Alabama. So I said I'll just drive around to a bunch of primary care docs offices and look for out-of-state cars in the parking lot, and the hood up and people asleep in the back seat, and a bunch of energy drinks and cigarettes on the ground, and I've found a pill mill.

Brian: You found it.

Dr. Lloyd: Right, and every single place I went to Brian looked legitimate, every one. I was heartbroken. So I drove back to the condo and right before the condo was a Rite Aid pharmacy. I pulled into that pharmacy, and I sat there, and I thought, you know I could write myself a script, I mean I can, I got a DEA license and those cross state lines. I thought, you know somebody will track that, and you can't prescribe for yourself, so I'll get caught. So, I got the idea I was gonna rob the pharmacy, and that's a pretty sobering thing to talk about. 'Cause I'm an east Tennessee boy, I've got guns.

Brian: Yeah.

Dr. Lloyd: I haven't shot any of them, but I got a bunch of them. You know I'm there in my car and that's what I'm contemplating. I know you guys will probably remember this, but a couple few years ago up in a little town called Bean Station in east Tennessee, there was a former police officer addicted to opioids that walked in a pharmacy, a little local pharmacy and he shot four people at point blank range. Killed two of them on the spot, the other two miraculously survived, in order to get opioids. A judge I work with up there was a judge in that case, and he actually showed the video of that when we were doing a talk one time. I made the mistake of not watching the video before the talk. So I'm sitting there watching this thing for the first time and judge doesn't know that story that I just told you. As I sat there and watched that, what you were talking about earlier, man that could have been me and I can't recover from that.

That young man wound up with two life sentences to run consecutively without the possibility of parole. That very well could have been me, and I promise you that somebody in the throes of addiction, there's nothing off limits of what they will eventually do in order to get their drug. There's just not. Luckily for me I had what people in 12 step groups call a moment of clarity. That moment of clarity for me was, I can't recover from this. If I do this, I can't bounce back from this.

The really weird thing is Brian, that's a pretty low point right there. I was just a few weeks away from being intervened on and getting to go to treatment. But even at that time, I didn't have any idea how to get help. I was there, I wanted to quit so badly, every single morning I got out of bed, I prayed to God I could quit that day. When I got back home, I had these duffle bags that I carry my clothes in back and forth to work, 'cause I'd work out or do stuff like that, run.

I had all these pills in the bottom of it, but they weren't opioids. I would Google how to get off of opioids and they said things like you know, symptomatic treatment, beta blockers, clonidine. So I had all these pills right, I got access 'cause I got them in my drug cabinet. So I was trying to detox myself, and the thing that I realized as I was getting those pills out of my bag after I got back from treatment was, I was doing a pretty good job of treating the symptoms, but I never stopped the drug.

Brian: Right.

Dr. Lloyd: So I didn't have any idea there was anybody could help me. I'd never heard of the Tennessee Medical Foundation. I mean I wouldn't know what that was, I would probably assumed it was the TMA.

Brian: Right.

Dr. Lloyd: So i just didn't know that there was anybody that could help me, and there was one particular day in the ICU that I gave up, pretty much. Keep in mind, I'm using that amount of drugs, I'm working every day.

Brian: I was wondering about that. You obviously get through medical school, you get your license, you're a practicing physician. If it is the fuel that keeps you going, you have to practice while on these medicines.

Dr. Lloyd: Oh no doubt, you put these boundaries out here for yourself. I've heard of drinkers doing it. I'm not gonna drink before five o'clock, all those things. Then you bust through it and you don't die and so you put another one out there. So that's kind of what I did, I wasn't gonna use at work. You have too, 'cause you're in withdrawals, you can't not use at work.

So I saw patients on a daily basis, impaired. As I've talked about this before, the scary thing for me was that I thought I was a better doctor. Because there were things that the normal person needs that I don't need anymore. I need very little food, I need almost no sleep, and I can work like a Trojan horse. I can, I can just ... I can go.

Brian: It's amazing how you can convince yourself of stuff. Look, I can work harder and I can keep going and you convince yourself that everybody says this is bad, and sure it's bad, but boy, look how much better it makes me at what I do.

Dr. Lloyd: This can really happen to anybody. I was really at the peak of my existence from an education standpoint. Then I started taking pills, all of a sudden I feel like I'm brighter, I feel like I can work harder, I feel like I can go longer, and there's all these positive rewards for that.

I was the top producing internist in my practice. All three years that I used, all three years that I used the students that I taught voted me the outstanding instructor in the field of internal medicine.

Brian: Wow.

Dr. Lloyd: The May graduation, before I went to treatment in July, I was recognized as one of the top ten instructors by the graduating students during their entire four years of med school. We got 230 faculty members.

Brian: I mean you're on top of your game.

Dr. Lloyd: Absolutely.

Brian: In every part of your career, and you're using narcotics and you feel like superman.

Dr. Lloyd: Every day, and I was rounding in the ICU at the time. You know the model, you're familiar with it, you've got the attending in the middle and then the med students. I call it the wondering mass of dullness, but that's probably not appropriate to say. But I was the attending in that and we always started in the ICU right, the sickest patients. That's where they are, so we did that every morning and we got down to the ICU one morning, and this was again towards the end, and there's a lot of things that happened there that really snowballed on me that helped me see the light.
But, we had a drug overdose come in the night before, and the intern was presenting to me and she'd overdosed on Tylenol. I took a moment back, we still had paper charts then, I took a moment back from writing my note and I said, how many did she take? I think he said 75. Well I was taking more than that every day.

Brian: And you're like, that's acetaminophen, and I'm taking narcotics.

Dr. Lloyd: Yeah, well I mean at the time I always wanted to get my hands on pure oxycodone 'cause I knew how bad I'd seen it. 'Cause you know this, if you work in a hospital, how many acetaminophen overdoses you treat. I mean a ton right. Way more than anything else. But I knew every one of those Hydrocodone, every one of those Lortab, every one of those Vicodin, every one of those combination drugs had 350, 375, 650 milligrams of Tylenol.

What I had done was, I knew what the antidote for Tylenol was N-acetylcysteine. Well I can't really get that out of the Ed., so I went to a health food store. They actually sell it in pill form and it's called liver health, but I turned around the bottle, it's N-acetylcysteine, and I didn't know the dose conversion. This is gonna sound crazy, but I would just kind of, I took half a bottle of Hydrocodone and I'd just take half a bottle of N-acetylcysteine and just figured it'd balance itself out. How crazy does that sound for a trained physician, but that's exactly what I did.

We were in the ICU that morning and the resident who I was working with that day, he looked at me and he said, he told me the number, and I couldn't write. I had my pen in my hand, I had the chart there, and I couldn't force my hand down to the note. The kids were all looking at me and I said, you know I'll tell you what guys, we're gonna do something a little different today, I said you guys got a bunch of work to do, you got dictation to get caught up on. I'm gonna save you from me today, and I'm gonna round my myself, and you all go off and get your work done.

I walked to the end, we were in the Johnson City Medical Center, and I walked to the end of the hallway at the time where our bathrooms were. I walked in that bathroom and I closed the door, I looked at myself in the mirror and I started to cry. I stayed in there for about an hour, and I thought I'm gonna die and nobody's gonna know. I really believed that, I didn't know that there was anybody who could help me.

I look back on it now and I think, you know what do you think they do Steve at the Betty Ford Center and Hazelton, 'cause I'd heard of those places. But I didn't think anybody could help me. I thought that I would die because I'd never, I don't know how this is gonna sound, I'd never been a mean guy. I'm not a mean guy. I wasn't the doctor throwing scalpels or cursing out staff, that was never me, that's not my personality.

When I would do things that should have raised an eyebrow, everybody would just laugh 'cause it was me. So Steve's rounding at 4:00 a.m., well he's a go getter. No, I was actually at home, couldn't sleep and thought, well I might as well go round. So, when you have a doc that's rounding at four in the morning that should raise a red flag. When you have a doc that's asking other docs to write him a prescription because he can't get a hold of his doc, that should raise a red flag. There's not a doctor patient relationship there.

Brian: Right.

Dr. Lloyd: And, most things that I did, I am grateful for them. I'm grateful for the experience. Stealing from my family, this may sound crazy, but I'm grateful for that experience because it helps me connect with people now. That's one of the most shameful things you can do. Usually when I'm having trouble connecting with somebody, I can always get them with that one. Because when I spit that one out, they go yeah, I did that too.

Brian: It's too close to home and it hurts too bad.

Dr. Lloyd: Yep, and now they've got me in front of them going, yeah, I did that. You didn't invent that. You know that really helps the connection, but all those things coming together helped me to finally see. But that moment of being in that ICU bathroom and just crying.

Brian: Was that your moment that everything started changing for you, that was the turnaround point that you knew if I don't get help, this is gonna be the end for me.

Dr. Lloyd: I knew I'd die. I knew I'd die because I wasn't on anybody's radar, I wasn't doing things that would get me on the radar.

Brian: So it wasn't like you were doing over prescribing, or prescribing yourself. From a medical standpoint, you were doing everything within the lines of where you were supposed to be practicing. So you're not gonna come up on any report, you're not gonna hit any data bank thing that people are gonna go, we really need to go and investigate Dr. Lloyd. It was a situation that somehow you managed to stay off of every flag out there and still practice at the top of your game, being a teacher, and still not getting caught. You had to come to the realization without somebody else intervening on yourself staring at yourself in the mirror of a bathroom in an ICU ward that I've gotta change. That was your moment.

Dr. Lloyd: It was, that was the very first one that really made me realize it. But if I had of lived, and I'm not convinced I would have lived, but I'd have lived, I think things were starting to fall apart on me. I had a couple of car wrecks in my own driveway. I didn't see a car there, I just backed into it. It can happen, but it shouldn't happen three times.

I had a wreck in the mountains of east Tennessee when I hit black ice, and going after a Christmas tree. I had my dad in the car with me up front and my wife and two children were in the back. I hit black ice and skidded, and we actually hit a dump truck that was parked on the side of the road loaded with bricks and cinder block. The dump truck bed came through and hit my dad in the head and cut him and knocked him out.

Of course, I looked over and thought he was dead. This is to give you some idea of the mindset, but once I realized he was alive, I knew that I was gonna have to go to the hospital, 'cause I had broken ribs, I could feel them, and they hurt bad. I said okay, I've gotta call ahead and make sure I get the right doc that won't drug screen me.

Brian: Wow.

Dr. Lloyd: Yep, I wasn't concerned about anything else. My kids are in the back seat, my wife is there, I've got my dad here beside of me bleeding, and my concern was, I've gotta get the right surgeon that I know won't drug screen me because he knows me.

Brian: That is a perfect picture of your family and everything you hold dear right there at your fingertips and your immediate concern goes to, I can't get caught 'cause then I can't get more drugs.

Dr. Lloyd: And if I can't get drugs I'll die. That's really it, when I'm out doing what I do now in my day to day job, that's what I want people to understand. I didn't wanna do that, I remember the day I went from taking a half to a whole. Remember 'cause I told you I started out taking a half.

Brian: Right.

Dr. Lloyd: I remember the day I went from taking a half one to a whole one. I remember looking at myself in the mirror that day and going, uh, there could be a problem here Steve. But I didn't feel anything and I wasn't anxious, I didn't have those depression symptoms. So I went on about my business, and it slowly climbed and climbed and climbed and then you know the first time I was dope sick, that's what I call it. But the first time I was within withdrawals, I didn't know what it was. I hadn't had Lortab for about a day and a half, and I was at a convenience mart and I thought gosh, I'm getting sick. I felt like I had the flu. In med school we learn about withdrawal symptoms, there's a list of them on the chalkboard right.

Brian: Sure.

Dr. Lloyd: I mean I didn't know, and I'm chilling, my bones are hurting, I'm sweating at the same time. My stomach's turning over and over, and I'm like golly I'm just getting sick. I got my hands on some Lortab probably a few hours later. When that first one hit my mouth, I was like, ah, I got it.

Brian: You figured it out.

Dr. Lloyd: That was an aha moment for me as well. But there was some things that were starting to slip towards the end. My dean of academic affairs, a really good guy, called me in his office, he says, Steve, your works' getting shoddy.

Brian: So that was kind of a first uh-oh, you better watch out because people are starting to take notice.

Dr. Lloyd: Yep, and he was a great guy. He was actually my first attending before he got the dean job. I really loved him and respected him, and I know for him that was a really hard thing to do. 'Cause I'd never had anything but success. He said, your works getting shoddy Steve, and I listened to that, and this one is a very telling one. As a clinician, every once in a while you'll go back and do lectures in the basic science years, in the first two years of med school.

So one of my biochemistry professors asked me to come back and do a talk on cholesterol. You know why cholesterol is important, he's in there drawing chemical pathways, but really the reason cholesterol is important and a risk factor for vascular disease, heart attack, stroke, all that stuff.

Brian: Right.

Dr. Lloyd: So I'm gonna go back and tie it in for the students. So I go and I do the lecture at the height of my impairment. The students filled out evaluations of my lecture. So back then I didn't read email. I figured that if you wanna talk to me, you can call me. So, there's obviously some things there that should have been signs, but that was one of them.

So I never saw those evaluations. So I guess what two years later, I get back from treatment. So in the meantime, those kids are gone on to their third year, and I've gone on to treatment. So when I got back, one of the things that I wanted to do was I wanted to get caught up on email. I went through all of them, and I promise you there were thousands of them.

Brian: Really.

Dr. Lloyd: It took me hour after hour. Some of them were dated and I could get rid of really quickly. One night I was sitting in my office, it was late, and I'd been out of treatment for about four months. I got out in October, so this was probably February, March. I'd already been back rotating with the students in the hospital and all that stuff, and I ran across that evaluation and I read it. There were comments in there like, can't believe this guys' a doctor. I sure hope I don't turn out like Dr. Lloyd, this guy's an embarrassment to our school.

Brian: Wow.

Dr. Lloyd: I'm already better now, but I'd always taken pride in my teaching. I'd always been recognized for it, so when I tell you there were signs, that was a sign I just didn't know it at the time.

Brian: Right.

Dr. Lloyd: And you know this, in the first two years of med school you're with these folks every day. The second two years, you never see each other, 'cause you're spread out all over everywhere. So I'm sitting there in my office and I'm like I'm not gonna be able to get these kids together.

So I sat at my computer and got the class distribution list, and I wrote them an email. I told them that I'd just read their evaluation, from two years ago when they were first year students and I thanked them. I said you know your comments, while they were very hurtful, were incredibly accurate. As I read them I cried, and I'm so grateful I'm not there today.

So in the meantime, we're getting near April of the year, I sent that email out right about March, and we get to April of the year, which is the time the students give out their teaching awards. They have a big banquet and I got noticed right off the bat that hey, you've been nominated for the outstanding instructor in internal medicine. I thought well that's not bad, I just got back from treatment if you know. So I went and I won, and the young lady who presented it to me, she's a gastroenterologist now, her name is Chivalli, and Chivalli said my name and I was sitting there I was like, oh wow, that's neat. I walked up and I hugged Chivalli, and she was in that first year class.

Brian: She was one of those-

Dr. Lloyd: One of those students right, and she whispered in my ear as she gave me the plaque, she said Dr. Lloyd, we all read that email and we couldn't even believe that was you. So they didn't even really associate that person with who I was now. So when we talk about neat moments, the little league thing was a neat moment. Professionally that one was a really neat moment 'cause I got to stand there for a second. The award was the award, what she said to me was paradigm shifting.

I was grateful for her words right then, 'cause I have always taken pride in that. So the things that I loved started to slip away. Family, the things I loved about work. I had a president of my university at that time, and dean at my med school, they didn't fire me. I'd had a good track record and they really protected me. They said, let's wait and see what we get back. I really grateful for those two men because while most people I went to treatment with had lost everything, I got paid the whole time I was gone.

Brian: Wow.

Dr. Lloyd: I never missed a paycheck. Those guys really propped me up and gave me an opportunity that I wanted to make sure that I honored. So far, 13 years later, I think that I have. I think that they're glad with the decision that they've made.  I'm not telling you I had to struggle at times.

Brian: Sure.

Dr. Lloyd: But I haven't relapsed, I haven't stuck a pill in my mouth, and my life revolves around educating people on addictive disease. I happen to be very fortunate to be a doctor, I'm pretty expensive to kick to the curbside. Cost a lot of money to make me ... state of Tennessee paid a lot to educate me.

You know we have people here in the state that don't have those same opportunities that I have. So I wanna make sure that I number one, honor that and number two, that I don't forget what I was given. That's what I try to do every day, that's why I try to do stuff like this. I don't remain anonymous, although you open yourself up because some people will come after you at times.

But, I found that the vast majority of the time, people are very kind and very forgiving, and we also know that 75% of them had been touched by addiction in their personal lives. So I think it gives people hope. If you never saw anybody who got better, you wouldn't have any hope.

Brian: That is so true, you have to see the successes to appreciate that I could get there. I wanna ask you, because I'm so drawn to that moment that you're looking at yourself in the mirror in that bathroom, and you're deciding, okay, I've gotta get help. For that person that might be out there today, either potentially listening to this podcast or knows someone that has a professor or a colleague or a fellow student or resident with them and they think, boy a lot of this I'm hearing sounds a little too familiar when it comes to Dr. Insert name here.

Give them advice, or give them some help of being that person looking in the mirror. What were the next steps that you took. The moment you hit bottom and you realized I've gotta get help, what did you do next?

Dr. Lloyd: I'd like to tell you it was me, but it wasn't. I wanna make this next part very clear, because the answer to your question is, you need to immediately call the Tennessee Medical Foundation, it'll be the best decision you ever make.

But I wanna lead into how I found them, because I didn't know that. I was taking my son down to meet my dad. My dad's an outdoor guy, loves to hike and all that, and my son was nine at the time. So, took him down to Jonesboro to meet my dad to go hiking, and I used to carry my pills in the drink holder of my truck. Right out in the open, right there, hundreds of them.

So I took Heath down to meet dad, I met him in the grocery store, and he's walked around the front of my truck. To this day, I mean even when I'm telling you this right now, I could have sworn I saw my dad walking away with Heath. Steve we're gonna take hiking, I'll bring him back to the house tomorrow.

Brian: Right.

Dr. Lloyd: So I saw him walk away, I reached over, I had 10 milligram Percocets in my drink holder. I took 15 of them, that's 150 milligrams, right in my mouth. That's 150 milligrams of Percocet like that. As soon as I got them swallowed, it takes something to swallow 15 of them at once. I turned around and my dad was standing right there, I mean right at my window. He looked at me and he said Steve, he said did you just take a handful of pills? You know what my answer was, no, I mean I didn't do what you just saw me do. You know that was my mindset. He shook his head and said all right, well be careful going home. I said okay, dad.

So next day when I was coming home from work, I rounded the corner, my house is up on the hill and I saw my dad's truck in the driveway of my house. I knew what he was there for, I knew before I ever pulled up in the driveway. I pulled up in the driveway and he's standing there and he said hey Steve, we need to go see your sister.

Well my parents had gotten divorced about ten years before, and me and my sister were estranged, I hadn't talked to her. I said I don't wanna go see her, he said yeah, he said let's go. So we got in the truck and we headed down the road and we get out to the interstate and he looks over at me and he said Steve, do you have a drug problem?  I said no dad, I ain't got a drug problem, I said I'm tired, I'm working multiple shifts, multiple hospitals and you know I'm young and I'm trying to get my practice established, and he said all right.

We drove another couple of miles up the road and he put his hand over on my knee and he had a little tear in his eye and he said Steve, he said you got a drug problem. I let out and I just broke down, I was the guy out in the middle of the ocean drowning and some body drives by or comes by on a boat and throws you a life ring and that's what dad did. I looked at him and I started crying and I said yeah dad, I do. I said I'ma lose everything, I said I'ma lose my medical license, I'ma lose my house, I'ma lose my family, I'ma lose my cars.

He shook his head and he said yeah he said, but none of that stuff is gonna do you any good if you're dead. I haven't really been able to figure out a comeback for that one yet. So we got over to my sisters office, and she's there, she's the one who actually told him she thought I had a problem. She saw me at Walmart or somewhere and said that's not my brother any more.

Brian: She could see it.

Dr. Lloyd: Yeah, and by the way she and I have a great relationship today, so ironically I brought that relationship back full circle. But, she got on the computer and said basically just Googled drug addicted doctors in Tennessee. Well, what pops up but something called the Tennessee Medical Foundation. She said, “have you ever heard of it”? I said, “no.” She said, “well, there's a guy here in Johnson City who is the branch of it up here, his name is Jack Woodside.” [He’s] a family medicine physician, and actually at my school. I worked with Jack, I knew him. So I called Jack, and he said yeah, come see me.

I went and saw him the next morning and I told him everything. He said yeah Steve, you're gonna need help, you're gonna need treatment. So he put me in contact with the TMF, they gave me a list of places I could go. It was one in Nashville called the Center for Professional Excellence, CPE-

Brian: Yes.

Dr. Lloyd: And it was at Grasmere, and I love Chip Dodd to death. Chip saved my life, but I tell Chip I said I didn't really research you very much buddy, you were in Nashville, my best friend lives in Nashville, and my wife is gonna kick me out of the house, I know it, so at least I'll have a place to go when I get out. So that's how I picked CPE.

So, the next day I was on the road from the tri-cities down to Nashville. I still had pills in my pocket, I still took pills all the way down. Matter of fact, the last pills that I ever had I walked to the corner of the parking lot at CPE and at the time, the gorillas were just on the other side of the fence and I tossed a Lortab over there to the gorillas, I hope I didn't hurt them.

Brian: I was gonna say, the zookeepers thank you for that.

Dr. Lloyd: Yeah, if you see some withdrawing gorillas down there, it was me. But I walked in CPE and they took a look at me and said, you know you need to go to Vanderbilt for detox. So I spent five and a half days at the Vanderbilt Institute for Treatment of Addiction, and I wanna say something about that.

There were 24 people on my service including me. At the end of that five days, I was the only one of the 24 that got to go to treatment. The rest of those kids went back to the street. I think about that every day. There's not a day goes by that that doesn't cross my mind in one form or another. These are great kids, they're young, they're kids. The little girl who was next to me is from Mount Julia, she was 19. I just won't forget them.

But I got that help there at Vanderbilt, then went to CPE and the very first night I got out of CPE, they had a doctors meeting for impaired physicians at a baptist hospital downtown. It was in July, July 13th, and it was hot. I had on a sweatshirt and I walked in and I met a guy named Roland Gray. He came up to me, he knew I was gonna be there, he put his arms around me and he said, Steve, he said, you're gonna be okay.

That night those guys and women in that room, I went around and they told how they got there. I'm sitting there drug addicted, coming off freezing to death, and I hear one guy who is the chief of orthopedic surgery at his hospital. Another guy that's moved into hospital administration, and he's the CEO of his hospital. Roland Gray, who's a pediatrician who is now the medical director for the Tennessee Medical Foundation, and it went like that all the way around the room, and for an hour I felt better. I was sitting there thinking well, these guys lives don't appear to be over and they've done some pretty bad stuff, and some of them have done stuff worse than me, and I started to get some hope.

So if you're out there right now, and you know somebody like this, first of all get involved. I see people all the time, it's none of my business. It's absolutely your business, they're gonna die, and I don't wanna go to their funeral. Get involved, the second thing is, call the Tennessee Medical Foundation. Now Roland has since retired, but we have a new medical director, Mike Barren, who is every bit Roland Gray.

Brian: He's a great guy.

Dr. Lloyd: He is, Mike is kind, compassionate. He's incredibly non-judgmental. I really couldn't think of anything that Mike wouldn't help me with now. So, our physicians in the state need to realize this resource is here. The weird thing is, I'm a proud member. I've been a member of the TMF for 13 years now and I'm very proud of that.

Brian: Sure.

Dr. Lloyd: When I go to get credentialed at a hospital or I took a job that I have now. They say have you ever had an issue with drugs or alcohol, and I write yes, please contact Roland Gray. I have never even gotten a whisper back about that, because I have maintained what I was supposed to do in my program with the urine drug screening. I completed my five year contract, I signed a lifetime contract after that because if I relapse, I hope I get caught early, I don't wanna die.

Brian: Right.

Dr. Lloyd: And my life has done nothing but climb up. So for the people out there right now who are still like that, you don't have to keep living like that. It's a horrible existence. Do I struggle now? Heck yeah. I have emotionally relapsed about 10 million times in the last week, but I have picked up and I've been given tools and I've been given resources and the friends I have are all friends I met through the TMF.

Brian: And they say you are never cured from addiction. It is a constant battle for years and years. To hear someone like yourself who is at this point to say, you know I still fight it, I still have that emotional component, it tells you that you can't do it by yourself for sure.

Dr. Lloyd: You can't, and that's one thing Brian that I wanna point out here, because I get people all the time that say you know Steve, we know that you battle this on a daily basis and it's a struggle, but it's not. I mean, if I had to go through every day white knuckling it, I'd have relapsed a long time ago.

Brian: Right.

Dr. Lloyd: So the truth is that it's not a daily struggle. The truth is is I live my life like you guys live yours.

Brian: Gotcha.

Dr. Lloyd: There are times that cravings happen, and it's been a while since I've had one and they've gotten less frequent through the years, but my relationships are what helps me, and struggles in my job over the past year and Mike realized that and gave me a call, offered me some words of encouragement and I know he's always there.

There was a book written on addiction in the past couple of years, and I recommend it to anybody who wants to learn about this. It's called Chasing the Scream, and it was written by a guy named Johann Hari, and Hari says at the end of his book, and he also says it at the end of his TED Talks. So if you want the book in 17 minutes, watch the TED Talk. He says at the end of his book, he said ... I think it's the last sentence in the book. He said the opposite of addiction is not recovery. The opposite of addiction is relationship.

That's what Chip Dodd taught me at CPE and that's what Roland Gray and Mike Barren and Mitch Mudder and all the people that are my friends now and continue to teach me. For those people out there who are isolated, alone, whose families are falling apart, it doesn't have to go down the drain. You have a resource in Tennessee that a lot of people don't know about, but I think it is the true diamond in our state because it didn't give me my old life back, my old life stunk, it gave me a life I couldn't dream of.

I've seen that happen time and time and time again. We're here at SVMIC, and so I was worried about am I gonna be able to get malpractice insurance when I wanna come back. They're like you know well you're under the advocacy of the TMF, and the SVMIC actually spends less money in claims on you guys that it does on their general population, and that's just the way it is. I had a doc down in Memphis the other night who was on the SVMIC board years ago.

The other thing Brian I've got to do, is I've got to go to other states and talk about the TMF. California, California has more impaired physicians than we have physicians. Yet, they do not have a physicians health program and their board of medical examiners basically turns a blind eye to it. I think that's tragic, not only for the physicians themselves, but think about me practicing.

I may have thought I was a better doc, but I was not a better doc, right. They don't have a mechanism. So, Tennessee's model with the Tennessee Medical Foundation, to me is the premier model in the United States. I think other states are close, I think Kentucky that I think of off the top of my head.

Brian: Yeah.

Dr. Lloyd: But the model that's been put together in our state and how it functions, while holding us accountable. It's not easy, and if they're things that happen, we're gonna be held accountable, and we're gonna have to take measures to do what we need to crack it or there's penalty.

Brian: Sure.

Dr. Lloyd: But the benefit far outweighs any downside.

Brian: Well I'll tell you Dr. Lloyd, I'm left almost speechless, and that's kind of hard to do with me if you know me very much. The information that you have provided to us today, our listeners, I feel confident that there is somebody out there that is going to hear this, that they needed to hear this podcast. This is something that they either needed to hear for themselves or a colleague, and your words and as you said, the success story is what's gonna help them get through, get the help they need, and I couldn't agree with you more that Tennessee Medical Foundation is exactly where they need to go to get that help.

Thank you so much, I can't tell you that enough of how much we appreciate you being here today.

Dr. Lloyd: You bet, that flew by. Thank you.

Speaker 1: Thank you for listening to this episode of Your Practice Made Perfect with your host Brian Fortenberry. Listen to more episodes, subscribe to the podcast and find show notes at SVMIC.com/podcast. The contents of this podcast are intended for informational purposes only and do not constitute legal advice. Policy holders are urged to consult with their personal attorney for legal advice as specific legal requirements may vary from state to state and change over time.