Heal Thyself

Rapid detox leaves a nurse suffering unforeseen side effects

Karen Augustine remembers being a nursing student in Pennsylvania, where she was raised, and hearing from her teachers that "one in seven nurses would become chemically impaired" in the course of their careers. She just didn't know at the time that she would be the one. And until the past few months, she didn't really know what she says she knows now, which is that working for a hospital "kind of sucks, because if you get sick it's a big deal." But when Karen Augustine recognized her sickness, and tried to get well, she discovered just how big a deal it can be.

Discount a slight tremor attributable to the aftermath of addiction and the nervousness of appearing in a newsroom, and Augustine looks every bit the nurse. She's a reassuringly sturdy woman with coiffed brown hair and an instantly familiar air, but today, as she would easily admit, she'd pass few people's muster as an ideal of the profession. Twelve years in the trenches of all manner of hospital wings has left her with an unnerving gallows humor, a cigarette habit and an authority-questioning bluntness that's bound to rub egos the wrong way in the ego-bound health-care industry. She's also a member of that human subspecies that uses the word "party" as a verb, as in: "To be really honest, I've partied all my life." By contrast, her immediate party problem -- an addiction to the painkiller Vicodin -- has been an on-again, off-again demon for only the past six years or so.

And yet by all available accounts, Karen Augustine has been, over those same six years, an exemplary nurse. Beverly Beck, in her role as nurse manager at Forest Springs Hospital, where both were then employed, reviewed Karen's performance in a "90-Day Evaluation Summary" in May 1995. Beck noted Augustine's "great personality," "caring attitude," "strong leadership abilities" and described her as someone who's "willing to be flexible and follows through with extra assignments as assigned." Under the heading "Areas Needing Improvement," Beck wrote that Augustine "performs at a level higher than that which is required." Beck must have remained upbeat in her appraisal. After moving to Cypress Creek Hospital as director of nurses, she was responsible for hiring Augustine on that institution's staff.

And it's not as if nobody was aware that Augustine had had run-ins with drug abuse. She had a history, after all, at the very same Cypress Creek, where, in 1994, she was enrolled as a patient, detoxing from painkillers, when a hospital therapist recommended her for a nursing position.

"I was a patient on Friday and I started work on Monday," Augustine remembers.

As with most people and their addictions, there are multiple possible explanations, contributing factors, excuses, what-have-you, for Augustine's drug abuse. While Augustine was working at one hospital in 1992, a window fell out of its frame and onto her head. The ER gave her the painkiller Lortab, which, it turned out, she liked. Then there's the fact, as Augustine claims, that her mother was abusive. And dovetailing into the nursing cliche, Augustine learned to give and give to her patients, but never to herself. "It could be that I was using drugs to mask a lot of that," she says.

But at the same time, as a licensed vocational nurse with 12 years' experience, the last four of them attending mostly psychiatric and chemical-dependency patients, she's aware that there are no black-and-white explanations, or excuses, for addiction. "I know I was a damn hypocrite, and that was partly the reason I was so frantic, because I hated living like that."

What her franticness led her to in early May of this year was yet another in a long line of attempts to kick. Having endured several runs at traditional cold-turkey detox -- withdrawal ordeals filling up to 72 hours with vomiting, nausea, diarrhea, cramping and severe shaking -- only to slip back into her habit, Augustine was primed for something more promising.

She thought she'd found it in an experimental procedure called ultra-rapid opioid detoxification under anesthesia, or URDUA. Popularized on ER episodes but still considered just slightly left of the dial in terms of widespread acceptance (which is to say that most insurance plans won't pay for it), ultra-rapid detox works like this: Patients are placed under general anesthesia and given monster doses of a drug called noxalone that jump-starts withdrawal, speeding patients through the detox process in about four hours. Because patients are anesthetized, they're unconscious and sedated through the roughest waters. When they wake, symptoms of physical opioid addiction are largely out of their system. And while ultra-rapid detox is no quick fix (there remains the significant trick of staying off the drug, for which most practitioners mandate a minimum of five days of outpatient drug-rehabilitation therapy), it's advertised as, for some patients, a superior way to achieve initial detox, which for many addicts is the most daunting blockade to recovery.

Ultra-rapid detox -- the cost of which ranges from $3,000 on up -- is currently offered by a limited number of hospitals around the country, including at Methodist Hospital in a study program under the auspices of Baylor College of Medicine, carried out by a Dr. Richard Silverman, an anesthesiologist at Methodist Hospital and Ben Taub General, as well as a clinical instructor at Baylor.

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