BY DARRYL GEBIEN, AS TOLD TO KATHERINE LAIDLAW
These are the words of the doctor in this story. If it can happen to a doctor, it can happen to you, your family, your friends or your neighbors. Click this link for additional info — http://torontolife.com/…/doctor-perfect-life-got-hooked-fe…/
I was just a year old when I had my first experience with opioids. I was born with a hiatal hernia, which constricted my esophagus and caused me to reflux like crazy. I couldn’t keep breast milk down and I became malnourished, tiny and weak. One night, my parents, Gayle and Morty Gebien, rushed me to the hospital. I was dehydrated and spitting up everything they tried to get me to eat or drink. The doctors told my parents to prepare themselves for the possibility that I wouldn’t live through the night. They brought me into surgery and gave me morphine for the pain. Maybe that’s where it all began.
I’ve always had a difficult time coping with stress. I sucked my thumb until I was eight years old. I started smoking at age 14 and never stopped. In high school, I was a pothead, and so were most of my friends. I dropped acid and did ecstasy a handful of times. Academically, I was apathetic, skipping class often and bringing home terrible report cards. One day, when I was 17, I went golfing with friends. When I got home, my back began to ache, a dull pain like a hand wrapping around my spine and squeezing it tight. I didn’t know it then, but I had a herniated disc. I lay down on the floor of my bedroom, and it felt like my vertebrae were shifting beneath me. Eventually, the sensation passed, and I got up.
The next year, I started volunteering at a hospital in Richmond Hill, folding blankets, mopping floors and stocking shelves. That’s when I first considered becoming a doctor. I studied science at the University of Toronto Scarborough, but my grades weren’t strong enough to get me into medical school, so I moved to Montreal and did a master’s in molecular biology at McGill. After that, I went to med school at the University of Queensland in Australia and did my residency in emergency medicine in Michigan.
In 2007, I visited my parents on vacation in Florida. I slept on the couch and, during the night, I displaced the disc in my back. The pain was much stronger than what I’d experienced in high school. My mother, who had prescriptions for her own back issues—she’d slipped on wet stairs a few years before I was born—gave me a powerful opioid called Dilaudid to soothe it. I knew I liked it too much. The back pain melted away, but so did everything else. It was like taking a happy pill. I immediately felt calm, relaxed, brighter and more wakeful than usual. Later that month, I sprained my thumb playing hockey. I went to the hospital, where the doctor asked me if I wanted codeine-based Tylenol 3s or oxycodone-based Percocet. I chose the latter. I knew Percs were the stronger of the two and I wanted to know just how strong. The feeling was great—similar to how I’d felt on Dilaudid that morning in Florida. My first bottle of Percocets—30 tiny white pills—lasted about a year.
In 2008, following stints as a cruise-ship doctor and an air-ambulance physician, I landed an ER job in Saint John, New Brunswick. At the bar one night, I met a blond girl named Katie, a personal support worker at a pain clinic. I was taken by her eyes, a light bluish-grey I’d never seen before. It took me a couple of tries, but, eventually, she agreed to go out with me. In February 2009, I moved back to Toronto to take a job as an ER doctor at the York Central Hospital, and Katie and her two-year-old daughter soon followed. They rented an apartment at Bathurst and Steeles, and began settling into a routine.
I found a new doctor in Toronto who prescribed me another 30 Percocets for my back, and I started taking them more often. After a few weeks, the pain subsided, and I stopped using them, but I stashed the extras, maybe half the bottle, in my medicine cabinet. One Friday night, some buddies came over for a few beers and some PlayStation golf, and I popped a few Percocets. It wasn’t some big decision, but, in hindsight, I realize that was the moment I crossed the line. It was the first time I took them purely recreationally. They gave me a fuzzy, happy feeling I couldn’t access any other way. Soon, I was dipping into my bottle once every few weeks—if Katie and I were going camping with friends or if I needed a boost of energy to play with Katie’s daughter after a long shift. She couldn’t tell when I was high and, at first, neither could Katie. The following year, in early 2011, we learned that Katie was pregnant with a boy and we bought a five-bedroom stone house at Bathurst and Sheppard.
My parents lived a short drive away and were proud grandparents. They were over at least once a week, but my mom and Katie didn’t get along. Katie felt they were too involved in her daughter’s life—they weren’t biologically related, after all. My mom would get upset if Katie’s daughter didn’t call her on her birthday. A series of slights, real and imagined, between my mother and Katie culminated in an exchange of profanity-laden emails. I became the rope in a vicious tug-of-war. My mother would tell me to assert myself and “be a man.” Katie would say I wasn’t standing up for her. Eventually, Katie asked me to choose between her and my parents. I was dedicated to making my life with Katie work, so I told my parents that they weren’t welcome at the house anymore. Shortly after that, Katie and I flew to Las Vegas to get married. A little more than a year later, she gave birth to our second child together, a girl. My parents weren’t there for the birth, which broke my heart.
The author with his wife and kids on his wedding night in 2012
Over time, I began to rely on the pills not just to help my back pain but also to cope emotionally. Initially, I went to my doctor every couple of months, then once a month and then every couple of weeks. He recommended that I exercise, lose weight and see a physiotherapist, but he always filled my prescription. He never told me it was too much.
In August 2012, I got a job as an emergency room doctor at the Royal Victoria Regional Health Centre in Barrie. Katie and I bought a spectacular five-bedroom house on the waterfront, at the end of a cul-de-sac. We had a dock and a boat. I was making roughly $300,000 a year. I bought Katie a Lexus SUV, which we eventually traded in for an Audi Q7. But our marriage was deteriorating. We were arguing all the time—about my family, about my parenting. I’d reprimand her daughter for misbehaving, and Katie would undermine me, saying, “Daddy’s just had a bad day.” Katie had also noticed my drug use, which had gone from two pills a day to as many as eight. We fought about it at least once a week. She wanted me to get help, but I always refused. Seeking help would have meant two things: one, admitting that I had a problem; and two, admitting that I was no longer in control. The pills helped me get through my days, and I wasn’t ready to let that go. Sometimes I slept in my car to avoid another fight.
The first time it occurred to me that I might have a drug problem, I was standing next to a lumber pile in Rona, waiting for my contractor to pick out aluminum framing for our basement renovation. I felt irritation wash over me, totally unprovoked. I couldn’t figure out what was wrong, but I popped a Percocet and immediately felt relieved. I wondered if I had been experiencing withdrawal symptoms, but I felt ashamed even considering it. I dealt with patients every day and didn’t see myself as one. Throughout my career as a doctor, I was trained to believe I was infallible. As far back as medical school, we were told that, no matter what, you don’t call in sick; you show up. So, even though I knew I was in trouble, I didn’t ask for help.
As the months went on, I continued using. That May, I was visiting my folks when I started having withdrawal symptoms. I asked my mom for a few fentanyl patches and she obliged, thinking that I just needed relief for my back pain. She had a prescription for the opioid, which is up to a hundred times more powerful than morphine. The intensely potent drug is usually doled out in surgery or given to patients with chronic pain who have built up a tolerance to other opioids. The transparent squares, which at the time looked a little like clear Band-Aids, contained two layers: one with the slow-release drug and one that’s skin adhesive. I slapped one on my back and stashed the others for later.
About a week later, I got home after a long shift and typed, “How to smoke fentanyl” into Google. My kids were with their nanny at the park near our house. I went to the garage and cut a patch into one-centimetre squares. I lined each piece up on a larger square of tin foil, then I held the lighter under the first piece, watched the puff of smoke come up and inhaled. The sweet smell of burnt plastic filled my nose and travelled deep into my lungs. It was as if I were being pushed by a powerful but gentle wave. Calm washed over me. My anxiety and fear were gone. I slowly lowered myself backward into a chair. I was higher than I’d ever been. Imagine a surge of confidence kicking in, a worldly reassurance that all of your problems will just dissolve. A soft happiness sets in, then a creativity spike. You feel totally alert, more awake and sharper than ever. Everything around you feels warmer. Now, imagine those sensations happening within a few milliseconds of each other. And that’s what it’s like to smoke fentanyl. I sat there, eyes glazed, staring out at the street for 20 minutes. I was in heaven.
Gayle Gebien, above, gave her son a few fentanyl patches for his back pain. He took them home and Googled “How to smoke fentanyl”
A drug like fentanyl doesn’t inject your body with new feelings; it borrows from the ones you already have. When the high starts to wear off, the positive sensations retreat and the negative ones become amplified. And addicts have no shortage of negative emotions. A dark cloud descends upon your brain. You become scared, anxious, agitated. The warmth rolls away and leaves you in cold sweats, shivering. Self-loathing kicks in, followed by guilt, fear, sadness, paranoia. Coming down off that first rush, my body began to ache. All I could focus on was escaping those feelings as quickly as possible, and the only solution was to smoke again. And again—each iteration sinking me deeper into dependency. From that day on, I smoked fentanyl at least six times a day and sometimes as many as 15 times.
The scariest part was that, as a doctor, I knew exactly what I was getting into, and I didn’t care. Fentanyl is one of the most dangerous opioids on the market. It can be smoked, injected or dissolved under your tongue. The federal health minister, Jane Philpott, has called Canada’s opioid problem a national public health crisis. In Ontario, 162 people died of fentanyl overdoses in 2015. In B.C., 332 people died in the first nine months of 2016.
Doctors are part of the problem. One of the most common complaints we get from patients is that we under-treat chronic pain. And, because pain is subjective and difficult to diagnose, we tend to take patients’ word for it when they say they’re in pain. Late last year, the College of Physicians and Surgeons announced it was investigating 86 doctors for prescribing daily opioid dosages that wildly exceeded national guidelines. One patient was prescribed the equivalent of 150 Tylenol 3s per day. Some of those cases occur because patients undergoing cancer treatment or living with multiple sclerosis may need very high dosages. But, in other cases, like mine, there’s rampant abuse of the system.
When I think about it now, I’m disgusted that I kept drugs in the same house as my children. At first, I locked up my patches in my toolbox in the garage. Later, I would smoke in the shower stall in our basement and hide my fentanyl under the sink behind the pipes. I convinced myself that, by taking those precautions, I was being a responsible father. I was high-functioning, but, still, my kids were getting a stoned daddy, even if they were too young to realize it. I wanted to believe that I was like any other doting dad—I took my kids to the beach in the summer, dunking the little ones in the water and wading hand in hand with the eldest. I took them apple-picking in the fall and tobogganing in the winter. The only difference was that, 15 times a day, I’d head to the basement to smoke up. That I was high around my kids is one of the hardest things for me to forgive of myself.
The author with his son at school in September 2013
That summer, my cravings were ruthless, and I had no legitimate access to patches. I knew I couldn’t write prescriptions in my own name, so I came up with a plan: I began to write prescriptions for Katie, then I’d go to the pharmacy to pick them up. But I didn’t want pharmacists getting suspicious of Katie, so I began to recruit other pretend patients. I had become friendly with one of the contractors renovating our basement. At one point, I asked him: “Can you do me a favour?” I explained that I needed someone to pick up my fentanyl and that I could supply him with Percocet if he agreed, which he did. I’d write two prescriptions in his name: one for fentanyl and one for Percocet. He’d get them both filled and keep the Percs. One night, my supply was dry and I was going through withdrawal. Katie and I were arguing, and I left the house. I got in a taxi and went into town. I was so desperate that I began going from taxi to taxi, knocking on windows and asking strangers, “Are you interested in doing a swap? I can get you Percocet, but I need you to pick up some fentanyl for me.” The first three weren’t interested. The fourth was.
From August to October, I also cajoled two assistants and a nurse into giving me painkillers from the hospital. I never offered to pay them; I just told them I was in a lot of pain and couldn’t write prescriptions in my own name. I put them in a terrible position and I minimized the stakes. “Oh, it’s not a big deal,” I said. They saw I was hurting and agreed. (They were later fired for it.) Over 16 months, I acquired 445 patches of fentanyl with fraudulent prescriptions, smoking about a patch a day.
Gebien wrote his own prescriptions, forging his colleagues’ signatures and hoping the pharmacists wouldn’t double-check
At home, my relationship with Katie was in tatters. Instead of offering support, Katie would yell at me, and I would yell back or retreat in silence. “You’re smoking again,” she would shout when she caught me going downstairs. She threatened to leave. She called me a junkie.
I never smoked before work. But I did wear a patch to stave off withdrawal symptoms. Twice I had to leave work because my cravings were too intense to keep going. I lost more than 30 pounds, my cheeks were sunken and I became irritable and jittery. Once, a colleague asked me if I was okay. I told her there were problems at home and left it at that. She didn’t ask again.
My mom had noticed my ragged state and, unbeknownst to me, called and told the hospital I might have a drug problem. My supervisor and the hospital’s chief of staff called me into a meeting and asked me if I had any problems they should be aware of. I lied. I said that things were rocky with Katie but, otherwise, no. They gave me pamphlets on addiction and mental health, and I went back to work.
I decided to change tactics. For the next four months, I forged prescriptions from other doctors in my own name. I’d go to the pharmacy and sweet-talk the staff—it was usually the same guy—into not faxing my prescription over to the hospital. Pharmacists hate to bother busy doctors, and I played on that. Every time I went to get one filled, I threatened everything: my job, my family, my freedom. I didn’t care.
One Sunday in November 2014, the pharmacist was too busy administering flu shots to speak to me and faxed the prescription. I could have tried harder to intervene, but, for some reason, I didn’t. My endless scheming had worn me down. The doctor who happened to pick it up in the ER was the same doctor whose signature I’d forged on the script, which requested a dozen patches. I didn’t know it then, but the doctor reported me to my supervisor. After 20 minutes of nervously waiting, I was waved over by the pharmacist. “We’ve run out of supplies, actually,” she said. She gave me what she claimed were her last few patches, and I went home none the wiser. Two days later, the chief of emergency and the chief of staff greeted me in the doctors’ change room. They told me that they knew about the false prescriptions, that the pharmacy had called the police and that I couldn’t work—I’d be going on unofficial leave without pay, and my medical licence would be suspended. I was scared shitless. The shame of being caught in a tangle of lies was overwhelming. I was afraid for my family, afraid I’d lose my job, afraid of what other people would say. I should have felt lucky to be alive—at that point I was a bag of skin and bones—but I just felt dizzying fear for the future. And yet, on top of all that was an unexpected wave of relief. My life had just come crashing down; at least I couldn’t deny it anymore.
I was arrested at home. Police charged me with three counts of forgery and gave me a notice to appear in court. Three days later, I went to Homewood Health Centre in Guelph, a facility recommended to me by a psychiatrist at my hospital, for five weeks. My parents covered the $10,000 bill. There, the doctors decided I should go into a rapid wean, a process intended to produce intense withdrawal and, with it, a deterrent to using drugs again. First, doctors gave me Suboxone, a pill used to get addicts off opiates. The drug satisfies some of the body’s narcotic cravings but doesn’t get you high. Coming off the Suboxone was vicious, as my endorphin levels plummeted and my brain began to rewire itself. I thought I was going to die. When I tried to walk, my body curled inward, neck down, arms tight to my chest, in a position known in rehab as the Suboxone shuffle. My ears were ringing. My body temperature began to swing like crazy: one moment I’d soothe my chills in a hot shower and the next I’d be running aimlessly outside, rubbing snow on my face. I remember telling the doctor that I couldn’t handle the pain. He agreed to give me another two milligrams of Suboxone to stave off my withdrawal. I knew that would only delay the inevitable, but, at that point, I didn’t care—I was so desperate I considered throwing myself in front of a bus. My body felt like it was disintegrating. Lifting a spoon to my mouth was tiring; walking up a ramp left me winded. The next day, I thought I was progressing, but, 32 hours later, I was still in the throes of withdrawal. I lay down on the hospital bed in my room to take a nap. When I woke up four hours later, the weakness was gone, my limbs had uncurled and my gait returned to normal. The week from hell was over.
On my 14th day in rehab, Katie brought the kids to visit. She told them that I was sick, and they assumed Homewood was a regular hospital. I’ll never forget my son asking why I wasn’t coming home with them that day.
My return from rehab was strange. Katie was exhausted from caring for the kids by herself for five weeks, and we were soon back to our bickering. I was sleeping on the couch and I was still on leave from my job, so my days were empty.
There’s a grieving process that comes with addiction, and I was grieving the loss of my drug of choice. The cycles of shame, self-loathing, rationalization and apathy returned. So I did what I always did to cope: I wrote a prescription for fentanyl using one of my old prescription pads. I didn’t realize the police were monitoring me.
Within a week, I was back to getting high 15 times a day. On the morning of January 4, I lost track of how much I’d smoked. I overdosed and collapsed in my basement shower stall. My face was a putrid shade of green, drool was dribbling down my chin and my dry tongue was hanging from my open mouth. I was barely breathing when Katie walked in. She had seen me high many times before, and she could spot the telltale bursts of energy, hoarse voice and constricted pupils, but that day was different. I’d been downstairs for longer than usual, and she hadn’t seen my face like that before. I remember her screams tearing through the fog in my head. “I’m calling an ambulance,” she cried. I jolted awake, flailing my arms as my paraphernalia went flying. I gasped for breath a few times, head lolling, then lunged for the toilet and vomited. “I thought you were dead,” she said. I told her I didn’t need an ambulance and, eventually, she stopped insisting, worn down from so many arguments. A few hours later, I was back in the stall lighting up another patch.
At 7 a.m. on January 19, 2015, 10 officers from the Barrie drug crimes unit showed up at my front door. If I have a rock bottom, I hit it that day. I woke to my three dogs barking and peered out the window to see the cops on the front steps. I opened the door in my underwear. “Sorry to do this, but your life is never going to be the same,” one of them said to me. I asked for a minute to put the dogs out in the backyard, and the officer agreed. Another went upstairs to tell Katie she would be arrested, too, wrongly thinking she was involved. They let me put my clothes on and have a cigarette in the garage. They handcuffed me as we were walking outside, so that my kids wouldn’t see if they came downstairs. I was taken to the police station and charged with 72 counts of trafficking—for compelling the pharmacist to supply drugs under false pretenses—plus six counts of forging prescriptions.
From January 19 to February 5, I was in jail at the North Correctional Centre in Penetanguishene awaiting my bail hearing. I was despondent. There was a stairwell on the second storey that overlooked the unit’s concrete floor, and I figured that if I jumped headfirst I would die. I told one guy I’d made friends with about my plan, and he pulled me aside. “Wait a second, motherfucker,” he said. “You’ve got your wife, your kids. That’s the most selfish thing you could do.” I went back to my cell. I hadn’t been using long enough after my first stint in rehab to go through acute withdrawal again, but I had the munchies like crazy, a sign of early recovery. I had an appetite so ferocious I’d chug the syrup that came with our French toast in the morning. My cellmate let me eat some of his snacks, too—Rice Krispies Treats, ketchup chips, Twix bars.
With the help of my parents, I made the $80,000 bail, but one of the conditions was that I live with my mom and dad at their Yonge and Sheppard condo. I went home briefly to collect my things. Katie wanted a stable environment for the kids, so she moved them back to New Brunswick 10 days later. I was devastated but didn’t have a choice. In April, I enrolled in Renascent, a clinic at Spadina and Bloor, for my second stint in rehab. I stayed for four weeks. During my daily walks in the neighbourhood, every time I saw a homeless person, I’d think to myself that I was closer to becoming one of them than I was prepared to admit. I was nearly out of money, my marriage was probably over and my network of friends had dwindled. I was initially represented by Marie Henein and Danielle Robitaille, the lawyers who represented former attorney general Michael Bryant and CBC host Jian Ghomeshi. I put the first payment of $35,000 on a line of credit but changed lawyers shortly after. I was still paying the mortgage on our home in Barrie and couldn’t keep up with their retainer.
In August, I walked into the Vitanova Foundation recovery centre in Woodbridge, another government-funded facility, not knowing how long I would be there. The centre offered a free rehab program and dorm-style residence, and, as the weeks passed, I felt my strength and clarity returning.
Three months later, on November 2, 2015, my 45th birthday, I got a call from my dad telling me that my mom had died. He’d found her in bed, non-responsive, wearing three 50-milligram fentanyl patches that we think she applied by accident. Her usual dose was a 25-milligram patch. It was the worst day of my life. I redoubled my efforts to stay clean. I checked out of Vitanova and moved back into my father’s condo. I slept on the couch and have continued to for the past two years. I FaceTime with my kids every couple of days, but it feels like no way to be a father. I’m on social assistance and help my dad with rent when I can—his pension isn’t enough to support both of us. Our Barrie home sold shortly after my mom’s death, and I gave most of the money to Katie, knowing that I might not be working much in the next few years. I run a flooring company with an old friend to make extra cash. And I’m still drug-free.
But my body hasn’t fully recovered: my short-term memory is spotty, I have hearing loss in my right ear and, for the first time in my life, I suffer from panic attacks. I apologized to the City of Barrie for betraying the trust of its residents. And I’ve done some outreach work, speaking to officials at the Ontario Ministry of Health and Toronto Public Health about how to tackle the opioid epidemic.
In April 2016, I filed for bankruptcy. Katie sent divorce papers a few months later. I had been hoping we’d find a way to make it as a couple, but I understood. In February, my biological kids came to stay with me for a week. I got to see my son—now five years old—skate for the first time; my little girl, who’s four, was so excited with the Hatchimal we picked out at Toys’R’Us that she carried the box around with her everywhere and showered me with hugs. I didn’t explain what was going on—I just said I’d talk to them soon. They’re too young to understand what happened. I worry about what they’ll think of me when they do find out. I hope they can be proud of my recovery, but that day is a long way away.
In December 2016, I pleaded guilty, and, as part of the deal, Katie’s charges were finally dropped. I’m awaiting my sentence. The Crown wants me locked up for eight years; my lawyer is arguing for house arrest. Most likely, the judge will settle on a multi-year prison term. My dad has early-stage Alzheimer’s, and I’m concerned about how he’ll cope while I’m gone. I worry constantly about Katie and our kids, too. I’m embarrassed that my life has become a cautionary tale, but I’m thankful that I got caught. Had I not been arrested, I’m certain I’d be dead right now.
When I get out, I will have to face the College of Physicians and Surgeons’ discipline committee, as is standard in cases like mine. My medical licence is currently suspended, and they’ll probably revoke it entirely. If they don’t, I plan to practise again, ideally in the area of addiction. I became a doctor so that I could help people. I messed up my life, but I can still help others avoid the same fate.