How did you get involved with this exhibit? It seems you would want to put your personal experience behind you.
A friend of mine in recovery sent me a post that they were asking for submissions. I sent my story in, and they got in touch with me. I’ve made it my life’s mission to study substance-use disorders. I’ve spent nearly every day of the last four years in various 12-step programs, and I’ve gotten to know a lot of recovering addicts. Doctors, lawyers, former prostitutes, homeless people; it doesn’t discriminate. I’ve been astounded by the commonality we all share.
What is that?
Childhood trauma. It’s pretty universal. Beatings, mostly. Violence in the household is very common.
Can you share your experience?
I was beaten with a belt a lot. It was a cultural thing, growing up in Puerto Rico in the ’60s and ’70s. That’s what parents did across the board. Kids would come to school every day with welts on their legs. It has changed a lot since then.
Have you struggled with addiction your whole life?
No. I smoked pot in high school, and I partied in college. I practiced medicine for a while in California and there was a lot of marijuana there, but it wasn’t life-consuming. But then I went into anesthesia, where opioid addiction is very common. It’s considered the No. 1 hazard of the job.
Access. Unbelievable stress. Sleep deprivation. It wears you down. When I first went into anesthesia, I told myself I’d never do that. I’d have to be stupid. But then as my career went on and changes were happening in medicine with corporate takeovers of hospitals, they kept increasing the pressure. At one point, I was working more than 100 hours per week.
When did you first take opioids?
I had surgery for a collapsed lung in 1992. It’s a very painful surgery, and I got morphine for that. The drug didn’t just take away my pain—it took all my worries away. It was like everything was perfect. Not everyone reacts to morphine that way. That’s where genetics and drug addiction come in, and apparently my genes are primed for that. My father was a successful eye surgeon, and he was a drug addict and alcoholic. My mom used Valium as mother’s little helper in the ’70s. I thought that was perfectly normal, but it wasn’t.
Were you addicted right away?
No, I didn’t abuse them initially, but the experience stuck with me. Fast forward many years, and I was completely burned out at work. One day, I went into my assigned operating room and someone had left a vial of Demerol in one of the anesthesia carts. I should have returned it to the pharmacy cart, but I thought, You know what? I remember that experience with morphine before, and I need that just this once. Just once. So I took it home with a clean syringe and I injected it. It was great. I felt relaxed. All my stress went away. I slept like I hadn’t in years. I woke up the next morning refreshed like I’d gone on a two-week vacation. It was fantastic.
Then what happened?
I went a few days without it. But there were some opioids left over after almost every surgery, and a few days later I thought, Ah, I need that again. Just one more time. Before long, I was fully addicted. And not only addicted, but physically dependent on it, where I had to do it just to function. The withdrawals were hitting me so hard during the day that I’d be throwing up, drenched in sweat, explosive diarrhea. I couldn’t do that in front of my patients, so I would get to the hospital extra early and give myself a dose to get through the day.
It sounds like it became all-consuming.
People think that addicts are indulging in their hedonism, but that is not the case. It’s a nightmare experience. It takes over your life. You end up doing horrible things not because you want to, but because the disease hijacks your brain’s survival mechanism. The withdrawals are beyond description. You rationalize all your actions because it becomes a matter of life and death.
How were you able to get away with it for so long?
When you’re an anesthesiologist in the operating room and opioids are left over after a case, you’re supposed to go find a nurse and waste it with a witness. Then you document that it was wasted. What I did—and what every addicted anesthesiologist does—is get a new syringe, fill it with saline, then waste the saline with the witness. Then I took the syringe with leftover opioids home with me.
How did you finally get caught?
After about a year, I got careless. I went to the bathroom and left a cracked vial of fentanyl and a syringe behind in the operating room, and a nurse found it. She turned me in to the department head. Thank God she did, because at that point, I was taking such huge doses that I would’ve been dead within a week, maybe two weeks at the most.
Were you fired immediately?
No, I was confronted by the head of anesthesiology and some other people from the hospital. Usually what happens in a case like this—and this was the plan for me—is that you’re sent to the Indiana State Medical Association’s physicians-help program. You go to rehab for three to four months, and then when you return to work, you sign a five-year contract with the program and they intensively monitor you with random drug tests. But I got back to work and the pharmacist had different plans for me. She started looking for discrepancies in the drug wastage record and reported me to the DEA. They subpoenaed my anesthesia records and referred them to the local prosecutor in Muncie, who investigated me for several months. One day, I was home and heard a loud knock on my door. There were five or six DEA agents outside and big black SUVs in front of my house. They let me call my wife, then arrested me and took me to jail. (Editor’s note: Ramos made a plea agreement with the prosecutor and was sentenced to two years of probation and 200 hours of community service.)
When you look back now, do you think you were compromised when you were using opioids at work?
I thought I wasn’t. I would have sworn I wasn’t, because when I really felt compromised was when I was withdrawing. In hindsight, though, after a few years of having my brain heal, yeah, I was compromised. Because I was not functioning at 100 percent of my capabilities, and I owed that to my patients.
Can you ever practice medicine again?
I could, but the obstacles are enormous. The board took away my license and said I could reapply in five years, with no guarantee that I would get it. I would have to retrain for a couple of years, retake the boards, and it would cost a lot of money. But here’s the thing with addicted anesthesiologists—the relapse rate is sky high. And I think something like 17 percent of anesthesiologists who relapse are found dead. I’m 55 years old now. With those numbers, I decided not to.
If you could design a system for dealing with physician addiction, what would it look like?
There needs to be an anonymous, discreet avenue for seeking help. I was desperate. If someone said to me, “Listen, you can get treatment and not have repercussions in your career,” I would have taken it in an instant, long before my addiction got to the point it did. That’s what needs to happen. But it’s not in place because of the stigma of the disease.
What are you doing now?
I’ve applied to a program to get a master’s degree in social work to become a psychotherapist and drug counselor. I’ve spent a lot of time trying to raise awareness to destigmatize substance-use disorders. I’m not going to stop until the day I die helping people understand that this disease is treatable. I’ve seen the possibilities of life in recovery. People can do remarkable things.