Overcoming Substance Use in Residency and Fellowship

Courtney Barrows McKeown is a general surgeon and esteemed athlete

Dr. Frances Mei Hardin: Welcome to this week’s episode of Promising Young Surgeon. This week, Courtney Barrows McKeown joins us to discuss her journey through residency and fellowship and overcoming substance use disorder. Courtney Barrows McKeown is a general surgeon and esteemed athlete. She has a long history of extraordinary academic achievements, graduating at the top of her medical school class and completing her surgery residency at Beth Israel Deaconess Medical Center, Harvard Medical School. She is a proud wife to Ian and dog mom to buddy, as well as auntie to eight nieces and nephews and big sister. She’s a huge Boston sports fan and athlete herself, including joining the rowing team in college. In her spare time, she enjoys golf, kayaking, and diy projects at home.

Courtney’s story is rich with struggles that many residents and fellows encounter

Thank you so much for joining me today, Courtney.

Dr. Courtney Barrows McKeown: Thank you for having me.

Dr. Frances Mei Hardin: Your story is very rich with, you know, the struggles that many residents and fellows encounter, as well as your own journey into sobriety and things on that side as well. What I love is how effective and positive you’ve been, as well as, like, the healing journey that you’ve taken and the power of sharing this healing journey with other people. And so, you know, how much I look, up to you for what you’ve done, including the rethinking residency interview on her full journey and things like that.

Dr. Courtney Barrows McKeown: Well, thank you. And, I mean, the respect and admiration goes both ways, of course. I’m really grateful, and it’s just obviously funny how the universe works in terms of how we even met in the first place. and things have really just taken off from there. So I’m, happy to be here and, share. Hopefully, somebody finds it, helpful, if nothing else, just to know that they’re not alone and that you can get through this.

Dr. Frances Mei Hardin: Absolutely. And, yes, I mean, of course, we’re not diving into this part deep today, but it was very serendipitous that we met. You know, surgery is a small world, and we met at a dinner party, and so that was pretty fun.

Dr. Courtney Barrows McKeown: Yeah. And I think it’s like, it’s funny. I mean. Cause I think it’s like, you know, it’s a helpful point of, like, you know, sometimes people will think that, you know, maybe I’m sounding like, pollyannish or something when things like, you know, like, oh, good things happen if you start doing the right things. And, like, you know, we actually met at my job interview. Right. which I will be starting with, Columbia surgical partners, hopefully in the next couple of months. Fingers crossed about licensing and credentialing and all that. The way I even found that job was through coaching, networking, and then, you know, doctor Vertrees invited you to the dinner that night. I was there, and we just hit it off, like, you know, it’s like that stepbrother’s quote, I think, did we just become best friends?

Dr. Frances Mei Hardin: Oh, my gosh. Yeah, we did not all of that is safe for, you know, podcasts.

Dr. Courtney Barrows McKeown: No, not. Definitely not. Maybe for another day.

Dr. Frances Mei Hardin: You know, doctor Vertrees and I just to make sure that everyone’s on the same page with background. So I actually work at a community hospital where doctor Vertrees also operates. She’s a general surgeon, and she owns and operates her own practice in Columbia, Tennessee. And she has brought on Courtney as her newest general surgery partner, you know, to join that practice. And so agreed. Like, what a. What a serendipitous meeting, and we’ve definitely connected a lot in terms of, like, journeys over the past several years.

Can you share what residency was like for you

And so to dive in, can you share what residency was like? Like, how did you feel going into work every day?

Dr. Courtney Barrows McKeown: Yeah. So, you know, and I’ve obviously heard some horror stories, especially from you, but also other people. And so, I don’t want to discount or discredit any of those things. It’s why it’s so important that, you know, we share the good and bad experiences, because, you know, quite frankly, I had a very. We’re talking overall very positive, good environment. you know, just as a disclaimer, like, any of the things I talk about today or, you know, these are purely, like, my experiences. I’m not a expert, in addiction. I’m not an expert in mental health. I’ve obviously, become very educated in both of those things. And, also just my experience in residency, you know, that was my experience. somebody, you know, everybody, I think, has their own take on it, but I think overall, like, the general vibe, though, was everybody was generally like, you know, this is not a malignant program, that’s for sure. And I obviously had a lot of experiences that, you know, make me look back on my residency very, very fondly.

Dr. Frances Mei Hardin: and I totally agree. Like, I want to share the good and the bad. And what I’ve always loved is that you have described yourself as a person who loves to operate like you were born to operate. You’re good at it. You love it. You’re like, put me back in the or and, like, just leave me in there. And so I love that, though. And I do think, of course, like, there are people who. Who were just born to operate. I love how much you love your job, your work and everything.

Courtney says she always felt supported by her residency director and chair

And so that’s why it is even all the more important that we, like, talk about the things in your training experience that went right where, like, you were supported. Well, you got hooked up to resources appropriately, and then you went on to excel, right?

Dr. Courtney Barrows McKeown: No, exactly. And, you know, it’s not all sunshine and rainbows. There’s, you know, and it’s funny because I did listen to your, episode with Doctor Umstadt, I think, your former senior, resident, a couple weeks ago. And, I’ve had similar things where either, you know, in residency or fellowship, like, there are chunks where I know they’re probably things I’ve forgotten, you know, like, whether it’s just, who knows? Like, my brain or just. It’s actually, like, trauma. But the point is, like, there were frustrating parts along the way. But I think the big message, was that there was always, like, we always had support. I always felt reported by our program director and our chair. And, it’s interesting because when I matched there in 2012, that’s when I started my residency. I entered a very different residency, although the same institution that somebody maybe five years before me had. and that was, you know, it’s not my story to tell, and I wasn’t there. I just have heard horror stories about the malignancy of that program, and it had to do with the individual, who was the chair of that department, who is no longer, obviously, and there were a lot of things. It wasn’t just the residents that he was toxic towards. It was, you know, colleagues and all that. And so when I. I remember when I interviewed there, I was thinking like, this, you know, this chair. His name is, doctor Elliot Chakoff. He’s a vascular surgeon. He was, like, the nicest person I’ve ever met. And I was like, you know, and that’s, like, my standard for person. Not even, like, a, you know, surgeon. It’s like, you almost get bonus points for being, you know, nice. He was just like, I can’t believe this person’s like, you know, this is the person I chose. So nice, you know? And he always would, like, remember, you know, like, he had a really good memory, about, like, random facts about people. So, like, you know, he kind of hung on to this thing, about me being a coxswain in college, on the rowing team. And, like, every time I’d be on his service, like, especially intern year, like, oh, Courtney. Like, rowing team, like, oh, how are things you know, like, very. And so that was, like, the environment I was going into, and it’s amazing. That tells you a lot about how the program, the institutional culture is. Is directly a, result of, you know, the culture leaders are m. I definitely agree.

Dr. Frances Mei Hardin: And, you know, the chair sets the tone for a department. And I also think that as a resident, you know, your program director is the person who, you know, you turn to if anything has gone awry, if you’re struggling. And so what’s funny, too, is that I think that a program director who maybe is an awesome program director during peace time, like that doesn’t necessarily mean that they’ll have all the skills when things do go off the rails and there are residents who are in need or struggling and things like that.

Would you be willing to talk a little bit about your first brush with substance use disorder

Right. In your training experience, would you be willing to talk a little bit about your first brush with substance use disorder?

Dr. Courtney Barrows McKeown: Yes. So I. Looking back, obviously, like, once I got into recovery for real a few years ago, which, not to, like, brag, but a few days ago, March 24 was my three year anniversary. I was very excited about that. But, you know, and I’ve done the work to get to stay that way. But, the point is that, looking back, my relationship with alcohol was really never normal. Like, I mean, I always, I never. It wasn’t like a. I really didn’t drink in high school. I was very much m. You know, very involved in athletics, played three sports all the way through, and was very focused on academics, and I was kind of socially awkward. And just high school was like, a very uncomfortable experience for me socially. So then I got to college, and, you know, you discover it, and it was like, you know, somebody described it as the social lubricant. And all of a sudden, I didn’t, you know, that I was clearly, like, as a child, just such an anxious kid. I just, you know, there was no label put on it, because. And I was very sensitive. I internalized a lot of stuff, and, it was like, oh, now, I don’t care what people think about me. This is great. And, like, I can. You know, it was a. So there’s that. But it was, you know, and there were times where I blacked out more than probably most people did. And definitely when I did drink, it was like my off switch was never really calibrated correctly is probably the best way to put it, but it never really became apparent until, at least two people in the workplace. which is actually an important point to bring up, but, in the workplace, until my research years in residency. So to back up, most general surgery residency programs, are five years. many of the academic centers such as mine have a seven year program with built in research time. So I did three clinical years and had, you know, I guess no problems would probably be an under. Like I was, did very well, you know, and I worked hard, but I earned a lot of respect from people. And so that honestly does play in a little bit, too, to how I think my perspective is on, like, support, because, you know, you’re performing well and, like, you have this reputation, and then you, you know, when you start declining, there’s a little bit more of an obvious shift. I went into research, and I was working with a mentor at the time who doesn’t work at that hospital anymore for different reasons. but he had me involved in a lot of different projects that were just, like, totally unrelated to each other. You know, I got overwhelmed pretty quickly. You know, you’re basically the first year, you’re kind of, it’s a little bit more lax. You’re doing, like, moonlighting schedules and kind of some of the social events kind of fun. And then, you know, the second year, you take over as, like, the overall resident schedule. So you’re involved in doing the block schedules, like, which residents go on which rotations, when there’s a lot of moving parts, you know, so I’m always a little sensitive to the fact that the culture, in the sense of, like, having control of your schedule and things like that. Like, I’m a little bit more sympathetic towards some of the educators because I can see, like, how it just can be, you know, so disruptive if it’s something like, silly that somebody wants to just, like, take a day off, like, how that’s not feasible. but you know what I mean?

Dr. Frances Mei Hardin: Totally.

In medical school, drinking to excess was very normalized

And I think that just to kind of piggyback on one thing that you mentioned earlier in terms of, like, a long history of an abnormal relationship with alcohol, I will say that in my experience in medical training and things like that, that is quite common and it’s very normalized. I think that in medical school, for instance, a lot of people were blacking out, drinking routinely, and a lot of those people also excelled academically, still graduated at the top of the class, and of course, you know, drinking was limited to evenings and parties and things like that. But culturally, it is definitely normalized. Like, I don’t think that anyone would blink an eye, you know, at that. Even in residency, same thing. Certainly, at least where I trained, like, drinking to excess after hours, evenings, you know, holidays, things like that. It was very normalized. And I just want to share, just, you know, because I think that this really validates, like, even your experience with it. I will say that one day we were talking about drinking in the operating room while we were, you know, in the middle of a case, and I said something to the effect of, this thing happened at work. It was upsetting. It was traumatic. You know, it was some whatever version of extreme bullying. You know, I was like, I was upset. I went home, I drank until I fell asleep, and the attending was like, yeah, you are supposed to bottle that up and do it once a quarter. He was like, you get once per quarter to, like, you know, go home, drink a whole handle of vodka, blow off some steam. That’s, like, the normal, appropriate way to handle your feelings. I was like, well, what if someone’s doing it more often than that? He was like, no, you get once per quarter. but again, culturally, this really shows, like, how normal, of a conversation those types of things are.

Dr. Courtney Barrows McKeown: Yeah. And I think, you know, to your point, I would tell people often, like, I think I partied just actually maybe harder in med school than I did in college. I mean, it wasn’t as frequently, but I, Oh, God. And at the time. So Ian and I have been, you know, together since. Actually been together almost 20 years, which is scary to think about. But, you know, we were off and on a little bit in med school, and when we first broke up, it was actually, you know, I claimed that it was, like, controlling. You know, I was so obsessed with, like, just going and doing the partying and the extracurriculars and, like, doing things like coming home and, you know, not proud of this, but, I mean, definitely wasn’t always completely. You’re not sober. Driving home. Blacked, out numerous times. In med school, when something becomes a problem, the first place is going to be noticed at home, and things are going to be. Problems at home are going to occur much earlier, and the duration can vary before they’re ever apparent because of how protective we are over our careers and how much we value them. Sadly, sometimes, at least in my case, I don’t feel this anymore. But at the time, I almost sort of valued it more than my marriage. That’s important to bring up, because, we tend to present later and sicker for that reason. Any of the things I talk about, too. Nobody made me drink. Nobody, like, regardless of the treatment, I received or perceived was going on, I have to be responsible for myself. So, that being said, I was feeling very much overwhelmed, and I clearly, I’ve been diagnosed now with anxiety disorder, generalized on a very low level of, ah, medication for that. And it’s really not an issue. But when you drink or use, other substances, that gets, you know, that can severely exacerbate those symptoms. And so my initial issue started actually with Adderall, which is an ADHD medication, also, you know, a stimulant. And I started taking it because I was feeling like there wasn’t enough time in the day. I never wanted to say no to any projects. You know, I was working in a bench research lab. I was doing outcomes research because I wanted to sort of have some little guarantee I’d get some publications if the things, you know, the research and the lab didn’t work out. I was also moonlighting to make extra money because you go and take. When you’re on research, you get a pay cut because you’re basically, like, getting grant funding. You’re not considered, like, you know, part of the PGY hierarchy of, salaries, you know?

Dr. Frances Mei Hardin: Yeah. And you’ve mentioned, like, how many different projects you had been assigned, how many different things that you had your hands into because, yes, you had the outcome studies they weren’t related to, like, the bench studies that you had to get up and running and, yes, admin duties and moonlighting and everything.

Adder: It’s difficult to say no in medical training

And I guess that one thing that you’ve mentioned in the past to me is just about how difficult it is to say no, which I think a lot of physicians could relate to at various points in their training. I mean, even as a medical student, if a resident’s like, hey, I’ll invite you to come onto this study to crunch data for me. Very hard pressed to say no. Same thing as a research resident. Like, do you even feel like you could have said no, thank you. If, in response to your mentor being like, I have just another project for you, I have another fifth task.

Dr. Courtney Barrows McKeown: I think I could have. You always have a choice. Like, I wasn’t going to get fired from my residency if I said no to projects, but I got kind of lured by the promises of publishing in, like, nature. And, you know, this is a. You’ll see. Historically, I tend to, you know, unfortunately, sometimes self sabotage in the sense of, like, I always go for things maybe because they sound amazing or, like, are prestigious sounding, but not because they’re necessarily in accordance with my values. And I’ve since trying to change that narrative, obviously. But, like, that was where I was at. At that time and in my fellowship time.

Dr. Frances Mei Hardin: Yes. And I love that, too, because the more that we, like, come to know ourselves and learn when things are not in alignment, then, yeah, this is kind of the start of healing. And so, you know, you are a powerhouse. Like, you have 25 publications and book chapters in total. So, you know, you’re a powerhouse. I feel I. You’ve certainly, like, I’m convinced, 25 publications and book chapters. You know, Harvard medical School training, I’m like, all right, you got me. Like, you know, you far exceeded, really, the threshold where people would be impressed, but I think that that’s where now you can play around. You have more room to play around with. Okay, well, what do I actually want? What’s in alignment with what I see for myself or want for myself and things like that.

Dr. Courtney Barrows McKeown: Yeah. And, so to your point, actually, a lot of those publications, I mean, some of them were, you know, I skipped on this part, but before medical school, I spent two years working in a research lab at children’s hospital Boston, mainly, to try and, like, I wasn’t, you know, I was a good student at BC, but I wasn’t, you know, I liked to party, and I wasn’t going to be like, you know, I wasn’t a shoe in to get into med school. So I did it for kind of maybe boost up my resume a little bit, but also to kind of figure out, like, I don’t know, maybe I want to do PhD, maybe I don’t want to be a doctor. I don’t know. And then I was in the lab, and I was like, nah, I saw this PhD grinding for, like, six years, and then she had to completely switch theses, and I was like, this is not. Yeah, not really for me. And I. And I liked. I realized I liked people it a little bit more than I then probably allows for anyone.

Dr. Frances Mei Hardin: I had something similar as well, just in terms of being on a biochem PhD kind of path before. I was, like, running gels by myself at two in the morning, and I was like, yeah, gosh, like, my friends are going to get to see patients and, like, talk to people. Like, I can’t do this anymore. But, you know, but actually, that’s so.

Dr. Courtney Barrows McKeown: The point I was trying to make. So I started taking this medication, which is supposed to help you focus, and, you know, to be honest, when I first took it, it seemed to work, hopefully. No. Now, this is like a biological process. It’s not, you know, a moral failing or something. My brain is wired differently than yours in terms of, like, how I react to mind altering substances. In my case, I have a very, actually a very strong family history that has in my, you know, both sides of my family, just not in my immediate. So it wasn’t like front and center my whole life, and it was almost not talked about, really. But that’s important because I think I was obviously at risk of having this happen if I started taking something that was potentially addictive. You know, that’s why I never had a normal relationship with alcohol. That’s why when I started taking Adderall, I went from taking a normal dose that people would take to, like, supra physiologic. What are you doing? You’re a doctor. You should. You should be getting an mi right now doses, right? And I didn’t get an mi, but I did get, I did have a psychotic episode, which is also a known symptom or adverse event of this medication, really for like an overdose of it. and that happened about a year or so after I started taking it. You know, the way our brains work with, especially people with addiction is you take something, you have this effect. Like, you get this. I mean, you literally get a dopamine rush. That’s the mechanism of action of that medication. It’s a dopamine reuptake inhibitor. And so my whole dopamine regulation process was totally haywire. Normal people, being people who don’t have addiction, may just stay on, like, that dose, or especially if you have ADHD, like, those medications are helpful. You know, I had to keep taking more and more to get the same effect because I was. Also felt that euphoria and tasks that seemed very hard to get motivated to do, or I just really didn’t want to all of a sudden became a lot more interesting. When you’re, like, on this medication, it obviously it’s a stimulant, so it also keeps you awake for longer periods of time. So, you know, in my mind, I was, like, getting more out of my day. But in the reality, it snowballed very quickly for me. Like, I may not have had the psychotic episode for a year or so, afterwards, but there were signs, like, fairly quickly that it was getting out of control. Those being when I started taking more and more doses, you know, I was getting, being late to meetings. The focus that I used to receive from it quickly, turned into, like, you get hyper focused on a very, like, mundane or unimportant task that would then make me completely unproductive, because, like, I didn’t, you know, I couldn’t even put a presentation together properly. I was starting to have panic attacks, which were very alarming, because I’ve never had those before, and I’ve never had another one since I stopped it. but those are directly a result of that. And, I think I’d shared before somewhere. I was at this national meeting, a couple months before I had the psychotic break, and I literally, I was supposed to present my plenary presentation. I couldn’t even put the presentation together. It was like, looking back, I was a little embarrassed, obviously, but then I stayed up most of that night trying to fix it, also drinking some wine to help me fall asleep for a few hours, which that’s how, like, those two things became very toxic together, because, you know, again, stimulants can’t. You can’t sleep. Shocker if you. Especially if you take them in, you know, later in the day. And so then I would try and, you know, counteract that. I was almost like, a little, like, you know, modern version of Halstead. I was taking my. My stimulant, which is basically, you know, that’s what cocaine is. And then I was instead, I wasn’t doing heroin, but I was trying to, you know, get the effects rid of by drinking so I could sleep. and that, both of those medications are just a recipe for disaster with, like, somebody who has anxiety. It’s gonna make it worse. Right?

Dr. Frances Mei Hardin: Yes. And I do wanna save for context. For anyone who doesn’t know who Halsted is, he is considered the father of modern surgery. And so, you know, in all seriousness, he was, utilizing or enhancing his performance and his practice of medicine with just tons of drugs. This is like, a, well known fact about him. You can read the book genius on the edge and things like that.

Everything we’re talking about, residency training, modern surgery are all based on cocaine

But it is funny because, fundamentally, everything we’re talking about, residency training, modern surgery, the culture, are all born out of this man on cocaine. And so, obviously, it’s funny, because Courtney and I, we do like to joke a little bit. Like, if you want us to keep that schedule, then you should give us cocaine. Like, I mean, obviously, that logically follows. People are just being asked to docain or change.

Dr. Courtney Barrows McKeown: Yeah, we have, like, sort of a weird, like, dark sense of humor that. That, works well together. Like, but it’s not for everybody, so. And, I should say, like, let me humble myself. Like, I, you know, Halstead was clearly very accomplished, and, like, I was not. Like, I wasn’t getting those level accomplishments, but in terms of the. My thought process of using the drugs to counteract each effect is more what I was going for. Yeah.

Dr. Frances Mei Hardin: Like, tite trading doses at home to.

Dr. Courtney Barrows McKeown: I felt a lot of shame about it when I first started, getting into treatment the first time because, like, oh, you’re a doctor. You should know better. Like, don’t, you know, taking unheard of doses of this medication. How did you not think that you would? And I didn’t think about that. That’s the whole point of this disease. It takes over. It hijacks your, like, executive functioning, your. Your judgment. you know, it’s all, like, amygdala driven now, and it’s all about, like, getting more of the drug so that you can. In my case, I was using it as what I thought was a performance enhancer because, like, overall, like, my goal was not to, like, be on drugs. It was to get, you know, do more, do what I thought would be better because I, you know, and I’ve learned that about myself. Like, I have to check that all the time, make sure that I’m not, like, trying to just run on this hamster wheel and, just for external validation or, you know, external accolades, you know, just being true myself, which, you know, people who are in addiction, like, they. That’s a core issue is that you’re kind of really. You’re just not in alignment with your values anymore, too.

Dr. Frances Mei Hardin: Right. And so when things did hit the fan.

Dr. Courtney Barrows McKeown: Yeah.

Dr. Frances Mei Hardin: With the psychotic break in training, how did that go down? And, you know, what did your program do? Right. And then we’ll kind of talk about fellowship a little bit.

There are signs that something isn’t right before a psychotic break

Dr. Courtney Barrows McKeown: Yeah. And, you know, I think it’s important to bring up, like, there, as I mentioned before, there are signs that something isn’t right. And that’s important, I think, not only for, you know, your listeners, who are probably more like the trainees, but also, leadership, because you never want to think that of somebody. And, like, you, you know, denial is. Is powerful, too, but when you see somebody who, you know, especially if you’ve known them for a long time and they’re acting out of character, I think in my case, that actually those signs were being picked up. I had a meeting maybe a month before this psychotic break because, you know, to his credit, this PI had talked to my program director and had concerns about, you know, everything that was going on. He didn’t know what was wrong with me. He’s just like, you know, she’s a mess. Like, she’s not getting anything done. Like, it was more like complaining, but, like, in the same sense, like, she clearly was concerned. And I do remember at some point having a meeting with her. Like, I just broke down crying in her office. Like, I was clearly just, you know, on the edge, and, like, she could tell that. And I was trying to protect myself. I didn’t know. I clearly, at that point, was not ready to admit what was going on. And so, you know, I definitely played it off. Like, you know, if he’s being a jerk and I’m like, I can’t deal with him. It’s toxic, and, you know, what should I do? And blah, blah. Kind of, you know, victimizing myself a little bit, intentionally. But, like, looking back now, you know, I think that I actually hindered my ability to get help earlier because she believed me. I think initially, you know, once you go into psychotic mode, like, your brain is no longer, you’re not in control of it anymore. And so in my case, I think what had happened was I had something upsetting happen in the, in the lab of, you know, like, some interaction with maybe with a PI. And somehow that just, like, set me off. And I, started, you know, I was still taking, like, very, very high doses of the medication, and, all of a sudden, I just couldn’t sleep anymore. Like, even when I stopped taking it, like, and then it would be like, two days I wasn’t sleeping. I started to, like, have delusions and stuff. And some of them, some of them I actually remember very vividly. and unfortunately, because I was, you know, my work was, like, my life, all of them revolved around work at that point. Obviously, my husband was involved, and he actually took me to my parents house because he was trying to work. And it wasn’t like, oh, just handing me off. He’s like, I don’t know what to do with her. He and my residency friend, they actually both took me to the hospital, and, they diagnosed me with a conversion disorder and sent me home. I didn’t tell them I was using anything, obviously, you know, those, those, I guess they didn’t have, like, a rapid drug screen, so clearly my urine test was positive for amphetamines. And, I thought I was there because I had burned my hand a couple of days ago cooking. Like, I had a pretty severe second degree burned on my, it was my right hand. So I was, I thought I was either there for that or I was somehow taking my friend to help her because she was, like, having a lot of stressors. So it was really funny. So I, like, I don’t know what I even said. I don’t remember the evaluation with a psychiatrist at all, but somehow, like, that got past them that I was clearly actively psychotic. And so they sent me home. And then the next, you know, this behavior continued at my parents home, which is about 30 minutes north of Boston. And my husband would come back, like, there every night after work. And, like, this last night, he was just like, you know, court, like, you need to get admitted to the hospital. We’re taking you to the hospital. They took me to a smaller place that was closer to my parents house. And he’s like, I don’t care what you have to do or what you have to say, but you need to get admitted. And, like, something in my mind, like, went like, okay.

Dr. Frances Mei Hardin: Did your husband know at this point?

Dr. Courtney Barrows McKeown: Yeah, he has ADHD. This all initially started because. Not, because of him, because, So one of the ways I got it was I took it from him. Stole it. That obviously, as you can imagine, having a long time, he knew he would confront me about it. sometimes, you know, most of the time, I just lied and said I didn’t do it. I think there are a couple times, like, I feel horrible about it now. Like, he assumes somebody, like, you know, some other individual did, and. But eventually he realized it, and I don’t, you know, it was causing very, like, a lot of problems that matters. It’s important to recognize, like, especially if your partner, well, it doesn’t matter what they do. You know, he’s a software engineer. He’s not a doctor. But I think that, like, that’s some of the struggle that the, you know, the partners, that’s why they have programs like Al Anon, you know, they have their own journey that they’re. That they’ve. The traumas we’ve put them through that they have to deal with. And, like, that’s, like, probably a big thing is, like, when do you, like, you know, way the, I don’t want to destroy her career and she’ll hate me forever. Or, you know, like, it’s in his position, like, I’m impossible.

Dr. Frances Mei Hardin: It sounds like he did know. He had, an understanding of what was going on, so he was right to kind of push you. He said, okay, like, this several day episode is continuing. I’m taking you back in.

Dr. Courtney Barrows McKeown: Yeah. And what was weird about it, I think what was hard for him to figure out was, like, he knew I was taking it. And at some point, and this is like, what’s so weird is it was, like, actually totally random. Like, I had, gotten a call or something that was like, a wrong number, but they were actually, like, it was actually a police officer. Like, they were looking for somebody and I was like, oh, that’s not like, like, what do you, you know, that’s not me. And they’re like, oh, I’m so sorry. Like, it must have been somebody had given them the wrong number. And maybe part of, you know, happened to just be random mind. But of course, like, I was actually starting to get psychotic. So you imagine you take a situation like that. That’s how I actually, like, sort of jumped to the, you know, in active psychotic mode. Like, everybody’s out to get me, you know, because. And so when that happened, I told my husband and he was like, who cares? Like, you know, like, he was confused about, like, why I was, like, so upset about it. I was like, and I finally showed him, like, you know, the medications I had been, like, stockpiling up, and I was like, I’m sorry, I can’t do this. And I took them along. I flushed him down the toilet, like, very dramatically, you know, so I went from taking like, a really, really high doses, just stopping, boom. you know, I mean that. But so he didn’t know, like, why. I mean, he knew I was clearly, like, deteriorating mentally. I don’t, he was confused about the fact that I had stopped taking it, but I think it was probably just the abrupt. Right. and so he did know that, that’s why he wanted me to get to the hospital the first time. And, you know, couldn’t, for some reason, they wouldn’t, you know, I don’t know.

Ian was hospitalized for suspected schizophrenia at a mental health hospital

I mean, they’re trying to, like, protect privacy, but, like, they interviewed me alone, you know, that I think is something that’s, you know, kind of a miss a little bit in the.

Dr. Frances Mei Hardin: Yeah, but I agree with you. Like, I’m shocked you. I’m shocked you passed the test. Although I’m not that shocked because, like, doctors can hide also. I mean, you know, in another, more real sense, I’m not shocked because, because, like, physicians are quite good at compartmentalizing. They’re good on autopilot. Those are all skills we have.

Dr. Courtney Barrows McKeown: And I am not a psychiatrist, so I don’t know what screen tools they have in terms of assessing. Like, okay, what’s conversion versus, psychosis? Like, where’s the line? And. But, yeah, so it’s actually fairly impressive to think, like, even when I didn’t have control of my brain, I somehow managed to, like, go under the radar for one hospital. Visit at least. And then, you know, he said that, and I with, like, you need to get admitted. And I was like, he’s kind of right. Like, there was part of me that was, like, still there. And so then I just started doing, like, crazy stuff, like, you know, I don’t know, hitting my head, you know, like, things that were, like, I knew I was doing intentionally, but, like, just to demonstrate the point that I’m, like, crazy, so to speak, and I need to be hospitalized. And this was a mental health hospital, like a crisis, you know, acute, not addiction focused. Even at that point, I still wasn’t, like, fully transparent about what I was taking, putting in my body. They obviously had some objective data from the drug test, but, it was like, question, you know, random psychotic disorder, new diagnosis of schizophrenia. Ah, maybe amphetamines. But, like, they weren’t a specialty, you know, addiction place. And that was actually a really scary, eight days. What happened was, and again, I was not technically really clinically working at that time. I was in research time, which was, I guess, somewhat of a blessing because, there was less of a concern about reporting stuff to medical boards and things like that. That being said, my program director, because I had called her, she knew what was going on. she was obviously, you know, she had been in communication with my friend who took me to the hospital first time. And, then I would find out later that when I was admitted, you know, she was talking to Ian, checking in occasionally, you know, first just to make sure I was okay. And then bring to his attention, like, needing to file FMLA paperwork so I would get paid while I was on leave. A month or so after I got discharged, I met with her. You know, I didn’t know what to expect going into it. My brain was definitely, like, it probably took me a solid three or four months before it was like, totally not, like, even a hinge, a hint of psychosis left. Like, it was very. I realized that it wasn’t. It’s not like an on off switch. So, like, I was. Probably appeared normal and stuff. But, like, my, executive functioning was clearly off. Cause I was like, oh, like, when can I start moonlighting again? You know, it was like, hello? Like, did you just see, like, know, what happened? You know, did you totally black out there?

Dr. Frances Mei Hardin: I wanna just highlight, like, to me, when I hear this story, like, the first time, hearing it again today, everything, what stands out to me was the way that your program director did take the time and the effort to reach out to your husband just separately, you know, while you were getting help, at least, because she did that, and she went over, like, the FMLA paperwork with him and everything. And honestly, like, just kudos to her. Cause I don’t think that every program director would be doing that. That’s kind of, like, above and beyond what I assume duties include. And it’s just like, it was such a loving, helpful thing. And, of course, like, hugely benefited you. You know, it’s just one of those logistical things where I’m so happy that somebody was looking out for you and your husband with that.

Dr. Courtney Barrows McKeown: Yeah.

Dr. Frances Mei Hardin: And I think, and I think that’s.

Dr. Courtney Barrows McKeown: Like, the key point is, like, you know, again, there’s always gonna be ups and downs on a residency. Like, residency itself is hard anyways, but even, you know, no program is perfect. But, like, things like that when, you know, like, even if things, you know, there’s some, oh, incident here or like, this person’s, you know, you kind of, like, when you know that you have, like, they’ve got your back, it’s. You think about those incidents differently. That’s why I also can, like, also empathize with the educators a little on some of the, you know, I’d hate for us to, like, overcorrect in terms of, like, culture, because I think it’s important to recognize this person. You know, clearly, she did a lot of above and beyond things. I mean, she’s a human, too. She’s a busy surgeon. She’s like, leadership positions, beyond program director in our hospital as a vice chair. She’s got two kids and a husband. Like, I mean, you know, she’s, you know, has family as well, and. And yet, you know, taking. And this is a busy residency program, like nine, you know, again, it’s a big program. And so I knew how off the hook her phone was all the time, having worked with her and the scheduling and, like, I’m still just amazed that you take that amount of time for somebody, in such a seemingly, like a. This shouldn’t be my job description task, you know? But, like, yeah, that says a lot. Honestly, anybody in a leadership position shouldn’t. If they’re dealing with physicians or have physicians that work under them, they should know about what physician health programs are because they are, in my opinion, an underutilized resource and they can help, you know, like, you can’t possibly, especially as a surgeon, like, know everything in terms of, like, mental health stuff as far as, like, evaluating and figuring out who is, you know, who’s okay and who should get, treatment, like, you know, and you bring it to this third party who actually takes some of the conflict out of it too, right? Because like now I can actually hate them. Like, I don’t have to, like in a way, you know what I mean? Like, because obviously I was not happy at first. But the one of the things she did was she was very well versed on the fact that we had one in our state, a physician health program. And it shouldn’t be taken lightly as far as referring somebody, you know. I did choose to tell certain people because I felt it was easier in terms of, some of the stuff I had to do afterwards with testing to like, than to have it shrouded in mystery and be like, where is she going now? You know? But that was my choice, you know, and I think that’s. I never knew any of the people. It was clear she had worked with other people before, even as the admin chief. Sometimes something would happen and she would say like, this person needs to be off. And I would, you know, naturally, like my first response is why? And just like, don’t worry. Like, you know, that’s you know, she said it in a nice way, but it’s like, it’s none of your business, you know, it what, you know, it shouldn’t be.

Dr. Frances Mei Hardin: Yeah, I think that that is something that like should be more ubiquitous throughout residency programs. Like, I think that’s probably the luck of the draw, but what a great culture to just say, hey, at any point the program director, can reach out to the admin resident and make like these schedule changes and it’s just like no questions asked and people aren’t in your business because I will say, like being in an eleven person total residency program, that’s very, very small in the grand scheme of things. And we didn’t have any systems like that in place in terms of protection. So you could just, you, you could go to either the senior resident or the program director potentially and ask. But, the senior residents, you know, there were no protections for the resident requesting x or Y or z. There was a total lack of discretion and then also respect for people who needed time.

Dr. Courtney Barrows McKeown: Right. And it wasn’t like every situation, like I knew most of the time why someone would be like sensitive stuff like that. Or maybe somebody you know. I mean, you know, sadly we’ve had people in our program who’ve had miscarriages or like, you know, things that is, if they don’t want to, you know, they shouldn’t have to have that known to everybody like, so I don’t need to know those things. But yeah, that, so she, you know, made it clear, like, well, I do need you to be evaluated by the physician health services, which is the PHP in Massachusetts, to make sure you’re okay.

Courtney Cunningham shares her story of recovery through writing

She didn’t know what was going on, and she’s like, you know, if you’re working with them, I don’t need to know anything. You can tell me as little or as much as you want. and at that time, I wasn’t really ready to tell her anything. She also had made it clear, like, you know, I didn’t have to work with that PI anymore. I’m sure it was a mutual feeling. before I had even met with her, she had already talked to our chair and ensured that actually the department would just cover my research salary for the year. because when you’re on research, your salary is typically given to you by your, PI through their funding, and obviously when you’re not working with them. So that was, something that she did also above and beyond. And my chair did, and then I worked with her and one of the newer endocrine surgeons who came in, which is actually a funny story because I actually published with him, and one of our co authors was a surgeon by the name of Carrie Lubitz at the time.

Dr. Frances Mei Hardin: Totally. And Carrie Cunningham’s talk like she’s a major national figure and speaker, as a physician who has had their own experience with a, journey through rehab and experience with the PHP program, and, you know, certainly wild professional success balanced with this healing journey that she describes publicly.

Dr. Courtney Barrows McKeown: That’s why I’m doing it, because, you know, some, I understand why some people don’t want to. I obviously have had stuff happen where my, my, dirty laundry, I guess, is like, out there. Like, if you googled me, you could find out, because I eventually did become known to the medical board. So from my perspective, I almost feel like a responsibility. Like, why not talk about it then? Because, you know, there is this side of the story out there and it doesn’t, you know, I’m almost like, taking control of the narrative a little. Like, I don’t feel like it’s as much of a courage thing for me. It’s like, well, it’s there anyways. Now I’m just like, actually giving my side of the story. And my point is, like, it’s, you know, some people will relate to, like, you never know what part of your story someone’s gonna latch onto or not, or like, like, ignore it, because they’re like, oh, this person’s, like, not, you know, it’s not attainable. They’re in a different career stage than me or a different stage in their journey than me. And, like, this doesn’t apply to me. So, like, the more stories that are out there, more variety, like, you know, that’s what you’re really trying to do is, like, just give some hope to that person who, you know, was me a few years ago.

Dr. Frances Mei Hardin: Well, I really appreciate that. And what I do want to kind of summarize with and also bring people up to speed to modern day is that, yes, we talked about a lot of heavy things and back, training, history, residency training, things like that. But Courtney, like, she talked about, number one, in the wake of receiving treatment, she had her most productive, you know, academic year. She hit the ground running, like, again, massive numbers of publications and book chapters and things like that. But not only that, but she is starting her new practice in middle Tennessee this spring, which is awesome. Like, we’re so excited to. To have her here, and we’re going to get to operate at the same hospital and things like that. But it really, like, I think that you guys can hear it. Like, I always. I’ve heard it from the second that I met you. You just come from this place that immediately is so wise and so healed. I mean, it even strikes me, you told me when we met, you were like, I honestly think I’m a better person now.

Dr. Courtney Barrows McKeown: Like, there’s no question. I mean, it’s that. That’s, like, the biggest gift you get from, you know, being in sobriety. And frankly, I think a lot of people should view recovery as a strength. I mean, regardless of. However I may have gotten there being somewhat self inflicted. Like, we went through an ordeal and got through it, and we went through, or, you know, and I went through a serious period of self reflection and discovery, took accountability for the things that, I played a part in, and without being victimized about it, took ownership of it. And so when you’re looking for someone to work for you, like, I mean, I would want someone who’s, clearly, like, has that perspective. Now, you’ll sometimes hear people who have gone through similar experiences and they’re blaming other people, and that would be a red flag to me. But, like, the sheer fact of someone actually being in recovery, regardless of what happened, you know, to a degree, I mean, you know, every state is different, so, like, I happen to get disciplined for something that wouldn’t be disciplined in other states. And I don’t say that to minimize at all for me, because I don’t think I would be here today, maybe even just literally, like, you know, on this earth had that not happened. I think it’s more important to just take a, not a one size fits all approach and, like, look at each case individually, not have blanket policies that say, we will never hire somebody who has x, y or z, or we’ll never, you know, board certify someone who’s had this issue. That’s the importance of sharing stories too. Like, there’s nuance to that. Like, you know, people obviously put their own, like, experiences into it and I think are a little bit biased, but I mean, you know, I went through some stuff, I took ownership for it. I became better because of it. I am better listener to my patients. I, on my best days, you know, I mean, everybody, I’m human, so I screw up still. But I’ve gone through other things in life, after being sober that I dealt with, in a productive manner and didn’t have to drink over, you know, a layoff, failing a board exam, family, deaths. And I got through that, you know, productively. These skills are not, you know, unique to recovery rooms. I mean, and that’s why I’ve noticed as I’ve gotten more involved in being coached and, obviously getting therapy, like, very similar principle. It’s very synergistic, like, so you don’t have to have an addiction to, like, get these skills. It just happens to be the structure in which I did. And clearly it also, you know, my ability to stay sober is contingent on me doing those things. These are skills everybody should have, and one form or another, like, coaching is a big thing. I think that’s an under, also underutilized resource, especially early in training, which is probably when we could use it the most.

Michael started drinking wine about three quarters into his fellowship

Dr. Frances Mei Hardin: Alrighty. And so then what was the transition, like in the aftermath? And going, sure.

Dr. Courtney Barrows McKeown: So, right, so, you know, I had about nine months after I initially, got evaluated by the physician health services. they actually did have me do an outpatient program for a month, rather than. They gave me a few options. But, like, some, you know, I think some doctors, like especially is a big complaint of the phps, is that they, you automatically have to go to this out of state place and pay, you know, a boatload of money because most of them are, are not, covered by insurance. And, that does happen a lot. Honestly, I’m not. In my case, I was really lucky. They, I think because enough time had passed, they let me do an outpatient program, which, you know, in retrospect, I probably didn’t get, like, a complete addiction treatment. but I, you know, was abstinent at that time. I signed a monitoring contract with them for three years, which requires a lot of different things, including drug tests randomly, you know, helpful things like seeing a psychiatrist and therapist regularly going to meetings and etcetera. But my whole goal at that time was like, okay, I just need to get back into residency. Like, that was sort of like, Michael, I never, you know, I really. That’s poor, just because I never really thought about this as, like, a, like, part of my identity yet. And that I actually had a level of. I did not have a level of acceptance, really. You know, having this disease of addiction. It was more like I made a mistake and let’s move on and let me get whatever I got to do to get back to work, I’ll do. And so I did that. I had, you know, my last two years of residency were great. I matched into a really competitive fellowship program, got a lot of, you know, some awards, and, you know, you leave residency as a feeling kind of like a rock star a little bit. And I do remember, one conversation I had with a vascular fellow at our hospital, and she said something very quick to me. It was just like, you know, when you go to fellowship, it can be really jarring, because all of a sudden you’re like, you feel like you’re on cloud nine, and then you go somewhere and nobody knows you, and you’re actually at the bottom of the totem pole again. And she was somebody actually, really a lot, and was, like, an amazing fellow. And, for some reason, that stuck with me, though, because, like, I didn’t, I sort of, like, put my blinders onto that. And it actually, she’s right. I mean, so I went to the fellowship. Things were going. I was sort of a walk. I was like a relapse waiting to happen, though. So, like, I was doing some things just to check boxes, and because I had to do them, I wasn’t, like, certainly never got a sponsor in any of those things. And ultimately, like, I ended up having a relapse. you know, about three quarters of the way into my fellowship, I never used, the adderall again, but I started drinking wine, and it initially started because I was having some negative emotions. I couldn’t, I didn’t have tools to manage and feeling, like, this impending sense of doom, like, I was terrible at my job. I wasn’t getting all the validation I was used to getting in residency. And, it just became like, you know, I was. It was too much for me to, like, really deal with, and I wasn’t really. If I was in recovery, I could have handled all of that honestly, especially for a year, but I didn’t. And then eventually, I had to, like, quiet those thoughts. And it’s a common thing we do. Like, we try to numb uncomfortable feelings. And I started drinking wine at home. you know, nothing was patient care related, but eventually it got found out on a urine test. And that was, you know, when I found out about that, I didn’t know exactly what was going to happen yet, but I knew it was going to be bad, because I knew I was going to get reported to the board as, my contract clearly stated that would happen if I had a positive test. And at that point, I was, you know, things in the marriage were bad because Ian, you know, he, again, it shows up in the household long before at work, and it never really showed up at work except the fact that I had a test that was positive. But, he, you know, I was lying to him. He was finding bottles. I was hiding. It was just like, it was all like that, and I was just so tired. I was like, you know, like, I actually want these rehabs, actually. Don’t sound too bad, like, you know, actually. And I can more just, like, escape, you know, if anything. But, like, I think I’m just tired and I’m, you know, of the lying and the stress and the all that. Like, I think I’m just ready to go get treatment. but then I obviously also had to deal with the consequences of what happened, and that was really hard. Honestly, at the time, I think I was still trying to figure out, is there a way I can, like, somehow get out of this to avoid, you know, destroying my career? And, that’s when the whole thing of, like, just being tired, you know, kind of played, and I was just, I’m sick of, of, like, playing this game. I would leave at normal work time and go out, do God knows whatever, and then come back and, like, so he just assumed I was going to work. and that went on for, you know, like, ten days or so, until one day on a Friday afternoon, I got an email from the GME department that said my fellowship was terminated. You know, that I violated, my employee health agreement, you know, with the hospital. And so that’s considered a substance use violation, which is, grounds for immediate termination and not appealable. And, I just, that was like rock bottom day. And so I went home, I left the house. I remember, I went into my car, grabbed a bottle of wine somewhere, and I parked in the park that was like a quarter mile from our house. And in the preceding week, I kept fantasizing about this bridge that was basically connected. Like, you know, I would drive bot over it when I would go to this community hospital occasionally to operate. And there was like a construction site that was abandoned below it. It wasn’t like, below it. There was like nothing in terms of people or other things you would like, you know, hurt if you were to get there. So I kept thinking, like, I could never picture myself doing some of these other methods, but I was, like, clearly contemplating suicide for a while because I couldn’t figure out a way past this whole thing. And I was so, my identity was completely wrapped up in being a surgeon. And I had gotten, like, almost there, you know, and then just, I also, I felt this burden of all of these people who kind of went to bat for me and were there for me. And I felt proud about, like, making them proud, you know, I’m letting all of them down too. And like, all of those things combined, especially with, like, the knowledge that in my mind I couldn’t see how I was ever going to, like, I thought my career was over. I really did, you know, clearly that’s not true, but, you know, when again, you’re stick to at that time and so you can’t really rational, like, lies to people. And, anyways, I had talked to my psychiatrist and I said, you know, I thought about all the things people do to end their life. Most of them don’t sound appealing, but there was this one thing I feel like maybe if I. It takes like 60 seconds or something to make this decision. And, maybe if I just had, like, a little liquid courage, I could actually do it. I don’t know if I’m going to. And the only thing, I think the thing that he hung up on was like, he asked about what about Ian. At that point, I was, you know, I just said our relationship was obviously, like, really messy. And I felt like he was better, better off without me, and he would find somebody else who, like, treats him better and maybe is better suited for him. And he eventually he would get over it. and there were, I had started looking up things like, what happens if your, spouse, like mister, resign. They have loan debt. And I said to the psychiatrist, like, well, he’s not going to get my loans either. Like, that’s, you know, the last thing that I could have burdened him with that I would be worried about. So I feel like, again, he gets to start with a clean slate. And I think that part about, like, me already looking into stuff like that, he, said, I feel like you’ve thought about this more than I feel comfortable with. Are you okay if I call Ian? And so then he called Ian, and I don’t know why I said, okay. I think I would just probably because I didn’t really want to, but again, like, where’s the line between when that actually could have happened? and then Ian came and got me, and, you know, I talked about this a little on the other podcast, but it was like, I was just totally distraught and was like, life, I know it.

I made you move all the way out here. I’m so glad that Ian came to get you

I made you move all the way out here. I’m not even, you know, a fellow here anymore. My career is over. Like, I, you know, I’ve ruined both of our lives. Every time I said of those things, he would, like, grab me by the face and just say, look into my eyes and say, I love you. I’m, like, I would say another thing. I love you. I’m, like, you know, he was trying to say, I don’t care. Like, I, you know, I mean, he does. We had a lot of work to do, but he just put that aside for the moment, and he took me home, and I was able to get into treatment shortly after that. It all breaks my heart. But, I mean, anybody who thinks they don’t have someone could, like, be, like, Ian and come get them, or a psychiatrist who they’ve had a trusting relationship with. And, you know, was able to skillfully navigate that without kind of, like, alienating me, you know? I mean, there’s, like, those are the things I like to hang on to when I talk about my story. And I don’t focus a lot on, like, some of the negatives because, honestly, there’s been way more, like, good people who’ve come into my path, even, and especially honestly, after this than, some of the bad. And even the bad stuff, like, was it really bad or was I just the way I, like, I’d be curious, like, almost, like, relive it. Not because I want to go back in time, but because I’d like to see, like, how. How I would think about it now, like, in my healthy, clear state.

Dr. Frances Mei Hardin: I am so glad that you’re here. I’m so glad that Ian came to get you. You know, like, absolutely. And of course, you know, a, huge congratulations on your three year plus now sobriety, because this is all huge. And obviously, I know that none of that was overnight. I know that it’s not like magic. It’s not like one day you’re in the park, the next day you’re three years sober. Coming from, like, this totally different, very healed space. I know that that’s not overnight and how we would not have been friends.

Dr. Courtney Barrows McKeown: Even, like, two years ago, probably. Like, that’s. Yeah, it takes work. But the point is, like, if you. You get what you put into it.

Frances May talks about her journey through residency and fellowship

Dr. Frances Mei Hardin: Well, thank you so much, sincerely, for joining me today and talking all about your journey through residency as well as fellowship and overcoming, you know, the setbacks that you’ve had to now be even better, stronger, you know, excited to open your own practice here this spring.

Dr. Courtney Barrows McKeown: Thank you for having me on. It’s been a pleasure.

Dr. Frances Mei Hardin: Next week, I will be doing another episode on strategy and playing the game of Residency with Colin. Follow me on Instagram at Francesmay, MD and rethinkingresidency. Visit my website, rethinkingresidency.com to learn more about resident physician stories and, ways that residents can most effectively navigate the game of residency. I can’t wait to connect with you on the next episode of promising young surgeons.