When thinking of how to describe our Medical Director, Dr. Marc Whitsett we couldn’t think of a better point of view than from his own daughter Natalie Whitsett. This is a guest post from Natalie which describes her dad Dr. Whitsett and his journey to an addiction doctor and our Medical Director.
The line rings three times before a voice answers by inquiring, “Dr. Whitsett?” These words are spoken with a practiced intonation that implies amicability yet formality, a formality that, as his daughter, I am unaccustomed to hearing. These words also catch me off guard without fail. During working hours, my dad is responsible for myriad patients, nurses, psychiatrists, and doctors; it is natural that this leadership position would encroach on his tone of voice. When I remind him that he’s talking to his daughter, not his patients, the stiffness in his voice evaporates. Suddenly, my dad is on the line, not Dr. Whitsett.
It is strange to juggle the two identities my dad inhabits – one as a father figure, the other as a respected physician. I have no doubt this dichotomy is striking for me because my dad is so… dorky. He wears his cell phone belt clip with oversized athletic shorts. He bought an umbrella hat for the solar eclipse this past August. I even think he is capable of subsisting solely on diet root beer, granola, and Nestlé’s semi-sweet chocolate chips. And yet, this same man is also the Medical Director at The Ridge Addiction Recovery Center, in Milford, Ohio.
While my dad has worked at The Ridge for three years now, his medical career began as a student at the University of Cincinnati College of Medicine in 1976. Over the last four decades, his professional experiences have included clinical work on the Arapaho Reservation, long hours in the emergency room, and occupational medicine. Since being introduced to addiction medicine in the late 90’s, though, he has found his true calling by offering effective treatment and compassion to stigmatized patients.
As I sat down at our surprisingly clear dinner table, my dad joked that he would fall asleep in his chair if we didn’t start the interview now. I checked my watch; the time was only 7:30. Perhaps this is a testament to the long hours he works every day.
Sitting adjacent to him, I noticed that my dad is starting to look his age – his once black hair has become a charcoal-grey color with flecks of silver. He was wearing a ratty t-shirt from Marco Island, our family vacation spot in Florida, and fleece pajama pants covered with red-nosed reindeer. His attentive blue eyes drifted between me and our rambunctious dog, Rudy, who was seeking out an unwilling playmate.
Our discussion turned to my dad’s decision to attend medical school at the University of Cincinnati. To my complete shock, his parents did not support the idea of medical school. “My mom actually thought I should be a minister or a nurse,” he shrugged. I was dumbfounded. My dad is spiritual, but certainly not a devout Christian. Yet, he managed to discover both inspiration and encouragement from a different family member: his brother, Jeff, who was about to accept a medical research fellowship at UC as well.
Upon starting the program, my dad recalled that his initial aspirations of becoming a surgeon were quickly derailed. He explained that “The demands and lifestyle [of surgery] were just not consistent with how I view happiness.” However, he named three professors in particular who stood out during his time at UC: Dr. Richard Vilter, Dr. Herb Flessa, and Dr. Vester. “They’re what I’d call ‘old-time’, great physicians,” he reminisced. “They demonstrated an enormous amount of compassion towards their patients.” I have no doubt their empathic approach to medicine shaped my dad’s own practice.
After a grueling eight years, my dad completed medical school. “But,” he emphatically remarked, “I was also broke.” To pay off some of his debt, he enlisted in the Public Health Service and worked on the Arapaho Indian Reservation in Ft. Washakie, Wyoming. For two years, he was the Clinical Director at the Arapaho Health Clinic. “I think I learned more than I gave back,” he said, reflecting on his time in Wyoming.
Following his work on the reservation, my dad began to practice emergency and occupational medicine – simultaneously. My mom chimed in saying that he was easily working at least 60 or 70 hours per week. Moreover, many of these hours were draining, stressful, even devastating. It was also at this time, though, that my dad was introduced to addiction medicine.
“I got a call from an orthopedic surgeon friend of mine,” my dad recounted, “asking if I would be willing to help them with the heroin addiction crisis in Clermont County. And I remember thinking, really? An addiction crisis?” The intonation of his voice expressed both incredulity and astonishment. Two decades ago, the opioid epidemic was not yet as sensationalized as it is in contemporary journalism, yet its epidemic nature was attracting the attention of medical professionals, such as my dad.
The pervasiveness of the opioid crisis in Clermont County demanded immediate action, so my dad and his colleagues created an O.T.P., or outpatient treatment program, which offered medication-assisted treatment (MAT) to opioid addicts. During the program’s inception, my dad initially tried to negotiate with the doctors who were feeding their patient’s addiction by over-prescribing opioids such as OxyContin and Percocet. With a sigh, he lamented, “These doctors would either hang up on me or flat out refused to listen to me.” It was unproductive to contend with a doctor’s ego.
Unfortunately, negotiating with willful doctors was not the only obstacle. There was, and still is, a resistance to MAT programs within the medical community and the public. Specifically, this opposition is due to the drugs administered in MAT programs, for Buprenorphine, or Suboxone, is an opiate like heroin or Percocet. “However,” he cautioned, “Buprenorphine is slightly different than other opiates because it’s a mixed agonist-antagonist. This means that when Buprenorphine hits the mu receptor – the heroin receptor in the brain – it stifles it.” In spite of its classification as an opioid, the chemical composition of Buprenorphine mutes the all-consuming craving to use. Moreover, since addiction irreversibly alters neural pathways in the brain, these patients will always crave their drug of choice. This is why medication-managed patients who also receive psychological treatment are by far the most successful patients.
Yet, there is still what he called a “widespread misconception” among professionals and the populace alike. “Many people mistakenly think that Buprenorphine treatment only replaces one opioid with another, but this is simply not the case,” he emphasized. “Unlike most opioids, there is no physical high or euphoria that accompanies buprenorphine even though there is physical withdrawal coming off of it. It’s not a drug of abuse.” His controlled frustration was palpable. He is trying to save these patients from imminent death, and this is no exaggeration. Statistics from the CDC state that “heroin-related overdose deaths have more than quadrupled since 2010.” Due to the availability of opioids and sadistic nature of this disease, such numbers will only continue to increase.
On top of opposition to MAT programs, many people stigmatize addiction as a willpower problem, or as poor choices, rather than a legitimate medical disorder. “It is a chemically-based brain disorder,” my dad impressed. Further expounding this statement, he explained that studies show that certain parts of the brain – the amygdala, the nucleus accumbens, the hippocampus – light up on scans when images of drugs of choice are shown to addicts. He said definitively, “The brain is responsible for this insatiable desire to use. Not the person.” In spite of empirical scientific evidence, though, the opinion that addiction is a choice is still pervasive.
This toxic stigma even persists within the medical community. My dad bemoaned that many doctors and nurses in hospitals shame addicts or simply don’t want to deal with them. “What gives these professionals the right to treat my patients poorly just because they stick needles in their arms?” he demanded. “They don’t need to be judged; they need treatment because they’re sick.” It is disheartening to think that trained, medical professionals are cruel to patients simply because of cultural stigma.
To combat widespread misconceptions which ignore the biochemical nature of addiction, treatment centers such as The Ridge Ohio exist. While these facilities treat a variety of addictions, including alcoholism, they frequently admit struggling opioid addicts. My dad first explained that “Any form of substance addiction is lifelong, un-curable, yet treatable.” There is no such thing as a recovered drug addict, but they can remain sober addicts.
“When a patient enters my facility, I ask them two questions,” he told me. “Do you like being an addict, and did you become an addict on purpose? They always answer no. And I tell them that you’re no different than my diabetic patients. I’m here to tell you that it’s not your fault.” As the medical director, he is able to offer these stigmatized patients something which they have seldom experienced as addicts: compassion. My dad disclosed that he felt such a connection with his patients because “they are unloved and judged by everyone in their lives.” That is why he feels an overwhelming responsibility to show them kindness and a lack of judgment.
When I asked him what The Ridge’s success rate was, he expressed that it has been challenging to gather data. He estimates that within the first few months, approximately 30% of his patients will relapse; after six months, they will lose another 20%. However, those six months mark a major milestone in a person’s recovery, for it is indicative of future success in managing this disease. “If I have nine patients in a row that fail,” he elaborated, “and I have one patient that succeeds, that’s all I need. It’s a miracle.” Without facilities such as The Ridge and doctors such as my dad, so many lives and identities would be lost: mothers, fathers, brothers, sisters, sons, and daughters. Addiction is not just a medical condition; it is a disease that impacts the entire family.
As my dad and I concluded our interview, we shared a comfortable silence at the dinner table. I absently rifled through my notes, trying to process the magnitude of my dad’s position. For my dad, being the Medical Director at The Ridge Ohio is not simply a title on a resume. It reflects the moral responsibility and deep affection he feels for these patients.
My dad looked at me, grinned, and let out a long sigh. “You know,” he said. “Maybe my mom was on to something.” I looked at him quizzically, remembering that she wanted him to be a priest. “Sometimes, I feel as though my job is similar to a minister’s. It’s my job to give these patients hope.”“Heroin Overdose Data.” Center for Disease Control and Prevention, 26 January 2017, https://www.cdc.gov/drugoverdose/data/heroin.html.