Something, anything to stop the pain
He was a star in his little hometown of Sperry, Okla., and in the big Boston hospital where he was a gifted anesthesiologist. But Brent Cambron was falling. For him, as for some of his peers, drugs meant to comfort patients became his refuge and his undoing.
He was dead when they found him in the storage closet at the hospital, probably had been for hours. And there was no doubt what had killed the man. Drugs and syringes were scattered all around his body.
There was a half-filled vial of propofol, a sedative used to put patients to sleep during surgery, and a syringe filled with midazolam, a powerful drug similar to Valium. There were empty vials of morphine, hydromorphone, and Demerol - addictive opiates capable of providing tremendous highs. And then there was one nearly empty vial of vecuronium - an intravenous muscle relaxant that, when taken at such a high dose, would shut down the body's respiratory system in roughly three minutes, leading to certain death.
Brent Cambron would have known that, better than almost anyone. He wasn't just intelligent - the pride of his hometown, tiny Sperry, Okla. - he had become an anesthesiologist at Beth Israel Deaconess Medical Center. He was highly trained to administer to patients the very medications that killed him, and he had every appearance of success.
Not only had he escaped small-town Oklahoma, as everyone back home knew he would, he had risen to near the top of his profession in Boston. He had a high-paying job and a posh Back Bay address. He had friends, and girlfriends, and all the promise in the world. Cambron was only 35.
But the drugs he used on his patients called to him in a way that haunts some anesthesiologists. Access led to a habit and cravings so powerful that even Cambron, who understood the risks involved, could not shake them. Long before his fellow doctors found him dead in the Beth Israel storage closet Oct. 14, Brent Cambron was slipping away.
He had lost weight, his job, and his reputation. Stints in rehab did not take, and promises to change did not last. He stole to feed his addiction, powerless against the drugs. And on July 3, 2007, he admitted it.
In police custody that night, after allegedly trying to steal drugs from Caritas Norwood Hospital, Cambron diagnosed himself. He told officers questioning him that he suffered from the "disease of addiction." When the officers asked what drugs he was addicted to, Cambron replied:
The medical profession is well aware of the risk of substance abuse for some anesthesiologists. It has worked in recent decades to develop protocols to limit access to anesthetics and increase awareness of the drugs' addictive qualities. And yet, too often, the people who know the most about such potent drugs are stealing them, using them, and sometimes dying as a result.
The number is relatively small; about 2 percent of anesthesiology residents are estimated to suffer from substance abuse. Still, studies have found that anesthesiologists are overrepresented among doctors seeking help for substance abuse. According to research, they have the highest rates of intravenous drug use, opiate dependence, and relapse among doctors. One 2005 study, surveying more than 100 anesthesiology residency programs, found that 80 percent of the programs had incidents of trainee impairment, and nearly 20 percent reported at least one death due to overdose or suicide between 1991 and 2001.
"It's a real problem," said Dr. Michael Nurok, an attending anesthesiologist at Brigham and Women's Hospital. "And I think it would be foolish for any program not to take the issue seriously and recognize, if they're playing the numbers, they're going to have problems."
Some recent research suggests that anesthesiologists may be more susceptible to addiction because they inhale low-level amounts of anesthetics exhaled by patients or absorb them through their skin while on the job. But others say the main problem is the ease of obtaining such powerful narcotics.
Unlike internists or pediatricians, anesthesiologists have at their disposal some of the most potent and addictive medications available. And unlike other doctors who dispense drugs by writing prescriptions, anesthesiologists order what a patient needs and then personally give it to patients in surgery. For a small number of anesthesiologists, the drugs prove to be irresistible, especially as patients repeatedly tell them how great the drugs make them feel.
"After you've been told that several thousand times, you start to think, 'This must be some good stuff,' " said Dr. William S. Jacobs, a University of Florida associate professor of anesthesiology who tried the drugs and became addicted about a decade ago and is now in recovery. "If this makes these patients feel that good, maybe it will make me feel good. And it only takes one try. You're off and running and out of control."
To try to reduce the likelihood that others might go that route, the anesthesiology department at Massachusetts General Hospital launched a random drug testing program in 2004. Dr. Michael Fitzsimons, the program administrator, said it has led to decreased incidents of substance abuse. But more data are needed to draw definitive conclusions about its effectiveness as a deterrent, he said.
Most hospitals still do not use random drug testing. Instead, hospitals including Beth Israel focus on educating doctors about the risks and tighten controls over the drugs. At Beth Israel, for example, anesthesiologists must check out medications from a pharmacy, chart what they use, and return the rest for a pharmacist's review.
"We believe our controlled substance practices are similar to virtually all other major academic medical centers," said Beth Israel spokesman Jerry Berger. "There are stringent regulations governing the use of controlled substances in operating rooms, and that's so we can be sure that they're used properly."
Even with such regulations in place, anesthesiologists say, it's easy to beat the system. Because different anesthesiologists working the same kind of surgery might give widely varying doses to patients, doctors looking to get high can easily inflate the amounts recorded on patients' charts and pocket the rest.
Exactly how Cambron pulled it off is unknown. Beth Israel officials declined to comment, citing hospital policy not to discuss personnel matters. And how Cambron gained access to the hospital - and the drugs - after being dismissed in June 2007 remains a mystery as well.
What's clear is that Cambron made a choice. Despite everything he knew about the addictive properties of the drugs, he started to use them. And once he did, he could not stop himself, even if it meant losing everything he had worked to achieve.
* * * * *
Cambron grew up in Sperry, Okla., population 1,031, just north of Tulsa. He spent his days riding four-wheelers, playing guitar in his bedroom, and tinkering with his computer, one of the few in town. There was no question that Cambron was going to get what he wanted, friends and former teachers recall.
"He wanted to get out of Sperry," said Debby Newman, who coached Cambron on Sperry High School's academic team 20 years ago. "He wanted to do something with his life. He wanted to better himself and he made it known that he didn't want to be stuck here."
And so, to no one's surprise, Cambron left. After graduating as valedictorian of his high school in 1991, he went on to earn undergraduate and medical degrees from Oklahoma University, where he partied like most of his college peers but earned better grades than just about all of them. And upon finishing medical school, he landed a coveted spot in Beth Israel's anesthesiology residency program in 2002.
Cambron got an apartment on Newbury Street amid the pricey boutiques and salons, collected ticket stubs from all the events he attended around town, and made a name for himself as a doctor who was both highly skilled and unflappable under pressure. He was respected enough to be voted chief resident in 2004 and then, after finishing his training two years later, Beth Israel brought him on staff. He was an attending physician in a field where doctors typically earn six-figure salaries, assisting in surgeries and helping patients suffering from chronic pain.
"My take on Brent was he was a very smart person, very clever. Things came easy for him," said Dr. Anasuya Vasudevan, an attending physician at Beth Israel who was an anesthesiology resident with Cambron. "And he was very courteous and humble. He wasn't headstrong."
But the affable doctor, who friends say was always more comfortable talking about others than talking about himself, was far less put together than he allowed others to know. In Boston, Cambron felt isolated, he admitted in recent years while seeking help. As early as 2002 - the first year of Cambron's residency at Beth Israel - he was concerned about his drinking, according to notes kept by Cambron documenting his troubles. And soon after a longtime girlfriend left him in 2005, according to those same notes, which were viewed by the Globe, Cambron began turning to the powerful drugs that eased his patients' pain, stealing them from Beth Israel when necessary.
Within the year, by his own account, Cambron became addicted, doing what he could to keep his problem secret, including once in 2006 when he blacked out, sliced open his forehead in a fall, and lied about it to people at work. But soon, at least one patient noticed that Cambron seemed troubled.
"I just knew that something was wrong with him," said Sue Wennerstrand, a 53-year-old Norwood woman suffering from chronic leg pain who was first examined by Cambron in January 2007.
"Everything was dirty" she said. "His shirt was dirty. His white coat was dirty. His fingers were dirty. He was very unkempt. And really, by the second time I saw him, that's when I realized I didn't want this person to be my physician."
Wennerstrand didn't have to worry about it for long, however. When she returned for her third appointment with Cambron in March last year, hospital officials told her Cambron was gone, Wennerstrand said, and that she would have to see a different doctor.
Within three months, Cambron would be out of work at Beth Israel for good. In June 2007, the hospital revoked his staff privileges and he signed a voluntary agreement not to practice medicine anywhere else in Massachusetts. He sought help through Physician Health Services, a nonprofit founded by the Massachusetts Medical Society to assist doctors struggling with mental health and substance abuse problems, and he even opened up to friends.
In a conversation that spring, John E. Thomas, Cambron's college roommate, recalls Cambron admitting his problems: that he was in rehab, concerned about getting his medical license back, and mortified that he had let down his friends and family.
"Come home," Thomas recalls begging Cambron.
His friend didn't listen, and Thomas thinks he understands why. There was no way that Cambron was returning to Sperry like this: as a fallen doctor in need of rehab. "Oh, my God," said Thomas. "That just would have been the scandal of the decade."
But in Boston, life was about to get even harder for Cambron.
* * * * *
It was the housekeeper who reported him first. About 10 p.m., on July 3, 2007, she told security at Caritas Norwood Hospital that a man had been holed up in a bathroom near the operating rooms for roughly three hours, preventing her from cleaning it.
Officers responded to find Brent Cambron wearing blue hospital scrubs and acting, according to police, like he was "on something." Under questioning, he admitted that he had stolen drugs, including the sedative propofol, from several rooms, stuffed them into his backpack, and then injected them into the femoral artery in his leg in the bathroom.
"It was all a big mistake," Cambron said as police booked and charged him with a litany of crimes. And it would not be his last. On April 25 this year, Cambron was arrested a second time - this time at Beth Israel - under similar circumstances. A security guard, responding to reports of a suspicious man roaming the halls with a backpack in hand around 9:30 p.m., reported finding Cambron in an exam room lurking behind a curtain.
As the guard pulled the curtain back, Cambron dropped a dozen needles on the ground. He looked startled, the security guard noted, and also "confused and unaware." He was handcuffed, placed against a wall, and charged with larceny, trespassing, and possession of drugs.
Within two weeks, he checked into High Watch Farm, a treatment facility in western Connecticut. He completed the facility's initial 21-day program and was "cooperative and compliant," according to officials who wrote letters on Cambron's behalf for his court case. On June 4 this year, High Watch officials, citing Cambron's "extraordinary commitment to recovery," accepted him into their long-term extended care program.
That program, according to the High Watch letters, typically lasts six months or longer. But Cambron didn't stay that long. Back in Boston, he had met and started to date a woman, Margaret Yoh, 24, an employee at a Beacon Hill antique gallery. Around the end of August, Yoh said, Cambron returned to Boston, moving back into his apartment overlooking Newbury Street.
Yoh, a recovering alcoholic, understood Cambron's issues better than many others did, and the pair went to Red Sox games and to local clubs to hear music, a passion of Cambron's. Even though he had left High Watch, he was dedicated to staying clean and sober, Yoh said. "He wouldn't even like it if I looked at a wine list," she recalled. "He'd rip it out of my hand."
But in the final weeks of his life, Cambron was under great stress. On Sept. 29, he lost a bid to suppress the statements he made to police in his arrest in Norwood, a blow to his case. Doctors overseeing his addiction treatment questioned his commitment, Yoh said, because he had left High Watch. "He kind of felt defeated," she said. And amid it all, Cambron remained ashamed, Yoh said, to the point that he skipped a friend's wedding recently, not wanting to face his former colleagues.
"He had everything going for him," Yoh said. "But he felt this tremendous amount of pressure to be infallible. And I think that pressure was a driving force for his addictive behavior."
But however well she understood him, Yoh said she never suspected that Cambron was considering using drugs again. The day before he was found dead last month in the closet at Beth Israel, the couple slept in, got coffee at a Back Bay
Around 5 p.m. that evening, Yoh called him, she said, to say she'd like to watch the movie sooner rather than later, so that she could get to bed early. Cambron didn't call back. So Yoh decided to send him a text message.
Again, no response.
Finally, at 6:20 p.m. that evening, Yoh sent him one last message.
"Love you," she wrote.
But Cambron never replied. The doctor had other plans that he wished to share with no one.
Keith O'Brien can be reached at firstname.lastname@example.org.