The New Republic

In December 2003, Brent Cambron gave himself his first injection of
morphine. Save for the fact that he was sticking the needle into his
own skin, the motion was familiar-- almost rote. Over the course of
the previous 17 months, as an anesthesia resident at Boston's Beth
Israel Deaconess Medical Center, Cambron had given hundreds of
injections. He would stick a syringe into a glass ampule of
fentanyl or morphine or Dilaudid, pulling up the plunger to draw
his dose. Then he'd inject the dose into his patient. If the patient
had been in a panic before her surgery, Cambron would watch her
drift into a pleasant, happy daze; if the patient had been moaning
in pain after surgery, he'd watch the relief spread across her face
as the pain went away. It was understandable, perhaps, that Cambron
was curious to experience these sensations himself, to feel what
his patients felt once the drugs began coursing through their
bodies. It could even be considered a clinical experiment of sorts.
"I had thought about it for a long time," he later confessed.The way in which Cambron handled his own injection reflected that
intense curiosity--but also a degree of caution. Although Cambron
had been a physician for less than two of his 30 years, in that
brief time he'd acquired a fund of knowledge that left him certain
he knew what he was doing. With his patients, he typically
delivered drugs intravenously, so that the medicine went directly
into their bloodstreams and its effects were immediate. Now that he
was delivering the drug to himself, he injected it into his muscle;
that way, the morphine would have to seep through layers of fat and
tissue before it began to circulate through his system, resulting
in a slower, less intense, and presumably safer high. An
intravenous injection, as one of Cambron's fellow residents would
say, is like "putting fuel on a fire," but an intramuscular
injection "is like putting a cookie in your mouth and letting it
soak, so that you're not really chewing it and it's not getting
into your stomach."

Cambron initially told no one of his decision to use morphine--not
his colleagues, not even his live-in girlfriend, from whom he hid
his syringes. What he was doing was illegal, and he knew others
would disapprove. But his shame was leavened by a certain amount of
confidence, even arrogance. During the 80-hour weeks he put in at
Beth Israel, a Harvard teaching hospital considered one of the best
in the world, he practiced medicine at its highest level. People
could quibble with other choices Cambron might make, but if he
chose to do something medical--even to himself--then it was, by
definition, the right choice.

That first injection of morphine, however, would quite possibly be
the last time Cambron actually chose to do drugs. As the needle
broke the skin and the morphine slowly seeped into his system that
December day, Cambron began to cede control over his own medical
powers. Before long, his career--and much more-- would be in
jeopardy.

The common conception of anesthesiologists is that they do little
more than put people to sleep while surgeons perform the true
medical miracles. The reality of their job is more complicated--not
to mention harrowing. In the course of putting a patient under, the
anesthesiologist must maintain the patient's delicate physiological
balance. Because the drugs he uses to put a patient to sleep often
lower the person's heart rate and blood pressure, the
anesthesiologist must administer other drugs to raise them. If the
surgery requires silencing the patient's brain and paralyzing his
muscles, then the anesthesiologist must control the patient's
breathing, since the patient can no longer do so himself. During a
surgery, in short, the anesthesiologist essentially takes over the
patient's basic life-preservation functions.

As frightening as this process sounds, it routinely enables patients
to undergo complex surgical procedures safely and without physical
pain. Before the mid-nineteenth century, when anesthesia began to
emerge as a medical specialty, this was rarely the case. Limbs were
amputated and teeth extracted while patients were sentient and
awake. Typical is a story recounted by a nineteenth-century Boston
surgeon who helped treat a young man with tongue cancer: "The
cancerous end ... was cut off by a sudden, swift stroke of the
knife, and then a red-hot iron was placed on the wound to cauterize
it. Driven frantic by the pain and the sizzle of searing flesh
inside his mouth, the young man escaped his restraints in an
explosive effort and had to be pursued until the cauterization was
complete, with his lower lip burned in the process."

Among the doctors troubled by the pain and suffering he caused his
patients was a young Connecticut dentist named Horace Wells. In
December 1844, Wells attended a performance by Gardner Quincy
Colton, a one-time medical student who had become a sort of
scientific showman. Colton invited a volunteer from the audience to
place in his mouth a wooden faucet connected to a rubber bag of
nitrous oxide. After inhaling the gas, Colton's volunteer ran around
the theater like a wild man, gashing his leg in the process. What
intrigued Wells, according to Henry W. Erving's The Discoverer of
Anesthesia: Dr. Horace Wells of Hartford, was that the volunteer
seemed impervious to pain. As it happened, Wells needed to have his
wisdom tooth removed. The next day, he had Colton give him a dose
of nitrous oxide, after which one of Wells's colleagues performed
the extraction. "I didn't feel it so much as the prick of a pin!"
Wells reported. He went on to give nitrous oxide to more than a
dozen patients, storing the gas in an animal bladder and then
asking them to suck it into their mouths via a wooden tube while he
held their nostrils shut.

A few years later, after some setbacks with nitrous oxide, Wells
began to experiment with chloroform as an anesthetic. As with
nitrous oxide, he experimented on himself. This time, though, Wells
developed an addiction to it-- which sent him into a downward
spiral. At the age of 33, after being arrested, he inhaled some
chloroform and then with a razor severed his femoral artery,
bleeding to death.

Today, anesthesiology has obviously come a long way from Wells's
animal bladder of laughing gas. But, for all its technological
advances, the specialty is still plagued by an addiction problem
among its practitioners. In 1987, the addiction medicine doctor G.
Douglas Talbott reviewed the files of 1,000 M.D.s who had enrolled
in the Medical Association of Georgia's Impaired Physicians
Program. He wanted to know how the drug-addicted physicians broke
down by age, gender, and, most importantly, medical specialty. What
Talbott discovered, and subsequently published in the Journal of
the American Medical Association, was disturbing: Although
anesthesiologists made up only 5 percent of the physician
population, they accounted for 13 percent of those physicians being
treated for drug addiction. The numbers Talbott found for younger
physicians were even worse: While anesthesia residents constituted
4.6 percent of all resident physicians, they accounted for 33.7
percent of residents in treatment for drug addiction.

No studies have found a correlation between the addiction rate and
medical error (although in 2002, a 31-year-old Washington State
woman suffered severe brain damage after her anesthesiologist, who
was addicted to Demerol, allegedly mismanaged her care during a
routine surgical procedure). But Talbott's article served as a
wake-up call to the specialty nonetheless. In the 20 years since
its publication, anesthesia departments have worked to educate their
members about the risk of addiction; they've become more vigilant
about monitoring access and use of drugs by members; and some have
even instituted mandatory urine tests for practitioners.

And yet, the problem has persisted. A 2005 study that surveyed more
than 100 anesthesiology residency programs found that, between 1991
and 2001, 80 percent of them had physicians who became addicted to
drugs during their training, and nearly 20 percent reported one
death due to overdose or suicide. "We've gone through lots of steps
to try to make it harder and harder, and that hasn't seemed to have
had a lot of impact," says Keith Berge, an anesthesiologist at the
Mayo Clinic in Minnesota who sits on the American Society of
Anesthesiologists (ASA) Committee on Occupational Health.
"Addiction," a recent article in the ASA's journal Anesthesiology
concluded, "is still considered by many to be an occupational
hazard for those involved in the practice of anesthesia."

When Brent Cambron arrived in Boston in the summer of 2002 to start
his residency at Beth Israel Deaconess Medical Center, he could
legitimately claim to be one of the top young anesthesia doctors in
the country--and that was before he'd even handled his first case.
Anesthesia is considered one of the most competitive specialties,
and the program at Beth Israel, with its Harvard affiliation, was
even more rarefied. It selected just twelve residents that year,
and those it chose were invariably at or near the top of their med
school classes.

That was certainly true of Cambron, a handsome young doctor with
close-cut brown hair, gentle green eyes, and a thin, athletic
build. But in other ways he didn't fit the typical Beth Israel
anesthesia resident profile. Unlike many of his colleagues, who
hailed from major metropolitan areas on the coasts, Cambron had
grown up in the no-stoplight town of Sperry, Oklahoma, about 15
miles north of Tulsa, the son of a data processor and a homemaker.
After scoring off the charts on his ACT test and graduating as his
high school class's valedictorian, he attended the University of
Oklahoma on a scholarship, matriculating to the University of
Oklahoma College of Medicine. From his days in Sperry to his time
in med school, Cambron had always sailed to the head of the class
with ease. "There were some people who had to put in fourteen hours
or so to learn the material, but it always seemed like Brent could
do it in about seven," recalls Matthew Paden, a medical school
classmate. "People would be incredibly stressed out and
sleep-deprived and pepped up on coffee, and then he'd come walking
down the hall with a smile on his face on his way to ride his
bike."

And yet, despite his whiz-kid status, Cambron seemed happiest when
he came off as ordinary. "You kind of had to know him for a while
to know how smart he was," says his college roommate John E.
Thomas. "He didn't flaunt it." Although he was a gifted musician,
the outlet he chose for his musical talents was a college party
cover band called Hummer. Even in that, he was content to stay in
the background, playing rhythm guitar and singing backup. "Brent was
very much a behind-the-scenes, below-the-radar kind of guy," says
James Suliburk, one of Cambron's bandmates who also went to college
and med school with him.

When it came time to do his residency, Cambron chose anesthesia,
which would provide him with good pay, reasonable hours, and plenty
of intellectual and emotional challenges. In their need for
constant vigilance, anesthesiologists are frequently likened to
airline pilots: Both jobs entail long periods of boredom punctuated
by moments of extreme terror. "From the moment you walk in the
hospital until the moment you leave, you're waiting for disaster to
happen, " says Ethan Bryson, an anesthesiologist at Mount Sinai
hospital in New York. "And [when it does], you have to be ready to
immediately intervene, recognize what's going on, and fix it,
because someone's life depends on it."

As low-key as he liked to appear, Cambron craved this type of
pressure. "If something was going to be difficult," says Thomas,
"Brent always took it on." While most of his medical school
classmates chose to do their residencies in Oklahoma, he decided to
travel the great geographic and mental distance to Beth Israel.

Cambron immediately took to Boston. He rented an apartment on
bustling Newbury Street, right in the heart of the ritzy Back Bay
neighborhood, and attended concerts and Red Sox games. At the same
time, he proved to be an excellent fit for Beth Israel. Even among
the first-year residents, who typically work slavish hours, Cambron
stood out for his penchant to get to the hospital early and leave
late--something one fellow resident attributed to his "Midwestern
work ethic." More importantly, during the long hours he spent at
the hospital, he impressed his colleagues with his clinical skills.
"Sometimes a resident isn't born with what we call the 'oh shit
gene' to recognize that something with a patient is quickly
deteriorating," says Anthony Hapgood, a former Beth Israel
anesthesia resident who was in the class ahead of Cambron's. "Brent
wasn't like that. He could recognize when something was going wrong.
He treated it early, and he treated it appropriately."

Cambron soon developed a reputation for levelheadedness during those
moments of extreme terror--a levelheadedness that was rare not only
in residents, but in more senior anesthesiologists, as well. Vivian
Jung Tanaka, another of Cambron's co-residents, remembers the
masterful way Cambron "ran codes"-- medical jargon for leading the
effort to resuscitate someone who's stopped breathing. "He was one
of those unusual people that, no matter what happened, he kept his
cool," she says. His placid demeanor was matched with a burning
intelligence. "I think the first two years, he got the highest score
on the practice board exam," says Suzanne Harrison, who was in
Cambron's resident class.

In July 2004, Cambron's fellow residents and senior colleagues
selected him to serve as a chief resident, one of the highest
honors a junior physician can receive. By the time he received that
honor, Cambron had been giving himself injections of morphine,
fentanyl, and Dilaudid for nearly eight months.

The drugs most frequently used in anesthesia today--such as the
opioids fentanyl and Dilaudid, as well as the sedative
propofol--are among the most potent in the history of medicine.
Dilaudid and fentanyl, for instance, are eight and 100 times more
potent than morphine, respectively. These drugs aren't only
powerful, they're also extremely addictive. Because they are
chemically engineered to have short half-lives, so that their
effects do not linger and patients can be safely discharged sooner
after their surgeries, recreational users of such drugs quickly
develop heightened tolerances to them, meaning that they have to
use more and more of the drugs in order to achieve their desired
highs. "There's a crash-and-burn phenomenon with these drugs," says
Paul Earley, the medical director of the Talbott Recovery Campus in
Atlanta, which specializes in treating impaired physicians.
"Whereas an alcoholic physician or one who's abusing oral narcotics
might not manifest obvious signs of addiction for years or even
decades, it's common for anesthesiologists to show up in treatment
six months or nine months or a year after their first time taking
one of these drugs."

Cambron was no stranger to recreational drug use. According to a
journal he kept, he was a heavy drinker in college and in medical
school; he also occasionally smoked marijuana. But maintaining a
hard-partying lifestyle in the midst of an ambitious academic
career seemed like the type of challenge that Cambron thrived on.
"We would go out and party all night and do the things college kids
do," recalls one of Cambron's college friends, "and then he'd get
up the next day and study for an hour and go take a midterm and ace
it." When Cambron arrived in Boston for his residency, he cut back
on his alcohol consumption. Soon, though, Cambron began to go out
drinking on weekends with some of the people in his program. In
December 2002, he found a resident who did cocaine and the two
began using together. When his co-resident couldn't get cocaine,
they would snort powdered Ritalin. In the year before he began
injecting himself with opioids, Cambron was drinking three or four
nights a week and using cocaine once or twice a month. Ironically,
once he tried the morphine, he liked it in part because it allowed
him to drink less.

When Cambron was appointed chief resident, it seemed to strengthen
his conviction that, when it came to his drug use, he knew what he
was doing. "I felt that things must be going well since everyone
thought I was doing well," he later wrote in his journal. Not long
after becoming chief, when Cambron began having trouble with his
girlfriend (who had moved with him to Boston from Oklahoma), he
increased the doses, along with the frequency, of his opioid
injections. And the frequency increased even further after Cambron
and his girlfriend broke up about halfway through his one-year term
as chief. He started spending more time socially with the residents
he supervised--including one, he discovered, who also took
intramuscular injections of morphine. They began doing the drugs
together. In January 2006, the resident revealed to Cambron that
she had started taking the drugs intravenously. Soon he was giving
himself regular i.v. injections of morphine, fentanyl, and Dilaudid
and occasional injections of propofol.

For a time, Cambron was able to manage his drug use as he had in the
past. Indeed, in July 2006, after he completed a fellowship in pain
medicine, Beth Israel hired him as an attending physician and he
became a clinical instructor of anesthesiology at Harvard Medical
School. But, before long, the i.v. injections left him with
cravings that he could only satisfy with ever larger and ever more
frequent doses. It became harder for him to conceal what he was
doing, and his work began to suffer. On one occasion, he fell after
giving himself an injection of propofol, splitting open his
forehead and leaving him with a black eye. The doctor who once got
to work early and left late was now getting to work late and
leaving early. Some of his colleagues told him he looked
"disheveled."

In December, a senior physician approached Cambron and asked if he
would meet with her after grand rounds the next day. When Cambron
looked at the schedule, he realized that the grand rounds speaker
was the director of the Massachusetts Medical Society's Physician
Health Services, a group that assists physicians struggling with
drug addiction. Cambron knew what was coming, but he came up with a
plan. His resident friend--who had recently returned from an
unsuccessful three-month stay at the Betty Ford clinic--had obtained
clean urine for her own regular drug tests. He took some of her
supply to work with him the next day. And when, after grand rounds,
he was confronted with suspicions that he was using drugs, he
agreed to produce a urine sample.

But Cambron could only avoid getting caught for so long. He
continued to use more and more frequently, injecting himself before
work and then taking syringes to use at the hospital. By the end of
January, he was giving himself i. v. injections of Dilaudid
throughout his days at the hospital and slurring his words for the
five or so minutes after each hit. Officials at Beth Israel
wouldn't comment on exactly how or when they discovered Cambron was
using drugs, citing hospital policy not to discuss personnel
matters, but, in early February, Cambron took a leave from the
hospital to enter a rehabilitation facility in Virginia that
specializes in treating impaired physicians.

On the night of July 3, 2007, Cambron put on blue hospital scrubs,
rented a Zipcar, and drove 20 miles from the Back Bay to a hospital
in the suburban town of Norwood, where he'd once done some
part-time work. Four weeks earlier, he'd returned to Boston from
the Virginia rehab facility. He was sober and committed to
recovery--and to going back to his old job at Beth Israel. Although
this would seem akin to, as one anesthesiologist friend of
Cambron's put it, "sending an alcoholic to work in a bar," it is
actually not uncommon. Anesthesiology residents who become addicted
and successfully complete recovery are often then redirected toward
lower-risk medical specialties. But those anesthesiologists who
have finished their training (as Cambron had) are more typically
permitted to return to the specialty, so long as they are monitored
by an impaired-physicians program--something Cambron had agreed to.

But, not long after getting back to Boston, Cambron was summoned to
a meeting at Beth Israel with the hospital vice president and the
chair of the anesthesia department, during which they asked him to
resign from the hospital staff and agree to a voluntary suspension
of his license. (Cambron's resident friend had earlier agreed to
these same conditions, although her medical license was ultimately
revoked.) Cambron acquiesced, but he was devastated. "I felt
betrayed by the people who were to have supported me," he wrote in
his journal. A week or so later, Cambron snuck into Beth Israel,
stole some propofol, and returned to his apartment, where he
injected himself.

Now, as Cambron walked into the mostly empty Norwood hospital--his
scrubs concealing the fact that he was, at that moment, prohibited
from practicing medicine--he was once again determined to get
sober. He carried with him used needles and some of his old
supplies. He was going to throw them away. Even in the throes of
addiction, he was still a physician and was a stickler when it came
to the disposal of hazardous materials. "He was worried someone
would get hurt going through the garbage," says Margaret Yoh, a
Boston woman who was Cambron's girlfriend. But Cambron couldn't
resist temptation. He swiped some propofol from an operating room,
locked himself in a bathroom near the endoscopy unit, and injected
the drug into his femoral artery. Before long a cleaning woman
tried to gain entrance to the bathroom, but Cambron wouldn't come
out. When he finally emerged over an hour later, hospital security
officers were waiting for him. They noticed the blood on his hand,
on his scrubs, and on the bathroom floor; they also noticed that
Cambron was acting like, as one of them later put it, he was "on
something." The security officers called the police. Cambron told
them that he'd come to Norwood to pick up a bag for an
anesthesiologist friend; the blood stains on his scrubs, he
explained, were old. "I don't know why you keep questioning me," he
protested. "This is no big deal." When they asked to search his
backpack he refused. He was placed under arrest for trespassing and
the officers then went through his bag, discovering a veritable
pharmacy. He was charged with larceny and drug possession. At the
police station, one of the officers asked Cambron if he was sick or
injured. He told them he had the "disease of addiction." "To what?"
the officer asked. "To everything," Cambron replied.

Cambron's father and his sister Kelly flew from Oklahoma to Boston
to bail him out of jail. Kelly stayed at Cambron's apartment over
the next several weeks to look after him. With a c.v. that now
included a failed stint in rehab and an arrest record, Cambron
seemed to have lost everything. But his medical license was still
only suspended, not revoked, and he continued to hold out hope he
could eventually return to anesthesia. He begged his sister to help
him understand why he felt the need to use drugs in the first
place. "He'd ask me if something went wrong in his childhood that
he felt he'd need them," Kelly recalls. "I tried to help him figure
that out and I couldn't. He was looking for any kind of reason for
why he'd feel he needed them, because he couldn't figure it out,
and it really bothered him."

The anesthesia specialty has been struggling with this question
itself: Why do so many of its members suffer from addiction? The
simplest--and most popular- -explanation is access. Anesthesia is
the only medical specialty in which physicians draw up, label, and
account for their own drugs. As such, they have more opportunities
than other physicians to abuse those drugs. "Anesthesiologists are
left alone with open ampules of highly potent narcotics, " explains
Berge, "and it's easy to divert for their own use." Cambron was
proof of that. Beth Israel Deaconess Medical Center, according to
its vice president for education Richard Schwartzstein, has
multiple policies and procedures in place to prevent such
diversion--including the requirement that anesthesiologists "waste"
whatever drugs they don't use on a patient in front of a witness or
that they return the unused drugs to the pharmacy, which are then
verified through random tests. But these safeguards proved no match
for a determined addict like Cambron. "Addicts are smart, we're
smart; they're desperate, we're not desperate," says Berge. "So
they're going to outsmart us every time."

In recent years, however, the access hypothesis has started to be
questioned. Its leading critic is Mark Gold, a psychiatrist and the
former chief of addiction medicine at the University of Florida's
McKnight Brain Institute. "If it's just holding the drugs," says
Gold, "the pharmacists have the drugs, so do drug-abuse
researchers, and not many of them become drug abusers or drug
dependent." In 2004, Gold presented an alternative hypothesis to
explain anesthesiology's addiction problem: exposure. Using gas
chromatography-mass spectroscopy equipment, Gold had researchers
scour several working operating rooms for traces of anesthetic
agents. Sure enough, even though the anesthetics were administered
intravenously, the researchers found throughout the operating rooms
trace amounts of fentanyl and propofol, which the patients had
exhaled. The highest concentrations were found around the patients'
heads--which is where the anesthesiologists typically sit during
surgeries. Gold, who did some of the pioneering work on secondhand
cigarette addiction during the 1990s, had his new hypothesis. "It
wasn't a great leap," he explains, "to say, possibly, that some
number of anesthesiologists who become drug abusers and
drug-addicted may have as an important contributory factor exposure
to secondhand drugs in the O.R. Their brains changed in response to
the secondhand drugs, and they developed cravings as if they were
taking the drugs themselves."

Most anesthesiologists and other addiction experts doubt exposure
can explain the problem, since the amounts of anesthetics found in
the operating room are so miniscule. "I think it's invoking an
incredibly complex explanation for something that has a much more
simple explanation," says Berge. And yet, even many of those who
subscribe to the access hypothesis concede that it's unsatisfying.
"I agree that access has something to do with it," says one
anesthesiologist, "but people have to want to take advantage of that
access. There has to be some other explanation."

Cambron's arrest started him on a vicious cycle of recovery and
relapse. Over the next year, he would make numerous, serial
attempts to get sober--again at the treatment facility in Virginia,
at McLean Hospital outside Boston, and at a retreat in rural
Connecticut that was started by Alcoholics Anonymous co- founder
Bill Wilson. In each instance (including after he was arrested a
second time, at Beth Israel), he would become sober for a while,
before eventually, inevitably relapsing. In this, he was hardly
unique. One 1990 study found that two-thirds of opioid-addicted
anesthesiology residents who returned to their programs relapsed.
Their continued access to drugs was surely a contributing factor,
but there was something else that seemed to prevent their recovery.

The first of the twelve steps to sobriety is for the addict to admit
that he is powerless over his addiction. The second step is to
believe that a power greater than himself could restore him to
sanity. But admitting this sort of powerlessness flies in the face
of what makes someone a good anesthesiologist to begin with. Some
anesthesiologists and addiction medicine specialists like to talk
about what they call the "AOA disease"--referring to the Alpha
Omega Alpha medical society, a sort of Phi Beta Kappa for med
school students. Because only the top medical students are able to
enter anesthesia residencies, it's a specialty stocked with
overachievers. "They're driven and they don't know how to take care
of themselves well, they're too compulsive about their work, they
can't let cases go, they're almost wound too tight," Earley says of
anesthesiologists. "And then, when the drug comes along, they just
feel like, ahhhhhhhhh, I can finally relax. And it's in that
experience that the setup for continued use occurs. If you've been
wound tight all your life, the first time you use narcotics, you
say to yourself, this is how normal people must feel." Raymond Roy,
the chair of the anesthesiology department at Wake Forest
University School of Medicine, relates some black humor that has
made the rounds in anesthesia circles: "How can you avoid having
any substance abusers in your residency? Recruit from the bottom of
your med school class."

Compounding the problem is the fact that anesthesiology doesn't only
draw overachievers but overachievers who, in order to succeed in
the specialty, must also be control freaks--and, in particular,
control freaks about drugs and the human body. "So much of what we
do as a physician and as a specialist is control someone else's
physiology," says Bryson. "We give what would be equivalent to a
lethal injection on a daily basis if we didn't intervene. A lot of
what we do is controlling the body's reaction to drugs. And I think
that creates a false sense that, if we can control what's going on
with somebody else, we should be able to control this in
ourselves."

Cambron certainly seemed to suffer from that delusion. "He always
told me that when he was taking these drugs, he knew exactly what
he was doing," says his sister Kelly, "that whenever he messed
around with stuff, because of his medical knowledge, he knew how
much to do without going overboard."

Sometime in the night on October 13 or in the early morning hours of
October 14, 2008, Cambron returned to the surgical suite on the
third floor of the Beth Israel Deaconess Medical Center's Shapiro
building. Once, the nine operating rooms there had been his
professional home, where he'd work on knee repairs and breast
biopsies and cataract surgeries. Now, they were simply a place where
he could get drugs. Because the surgical suite in the Shapiro
building was reserved for outpatient procedures, Cambron knew it
would be empty at night. As he walked through the maze of hallways
and through a series of imposing double doors, no one challenged
his presence.

Cambron assembled his stash: It included five syringes, a
50-milligram vial of Demerol, four ten-milligram bottles of
morphine, four ten-milligram bottles of Dilaudid, and a
ten-milligram bottle of vecuronium--a muscle relaxant that, taken
at high doses, will cause respiratory arrest in a matter of minutes.
He brought all of it into a small room that bore the label "soiled
utility" and was used to clean anesthesia equipment, closed the
door, and began to inject himself.

At about 7:30 a.m., an anesthesia technician, who was making her
morning rounds before the day's first surgery, opened the door.
Cambron was sprawled on the floor between two stainless steel wash
basins, his body surrounded by needles and empty vials, including,
most ominously, the ten-milligram bottle of vecuronium. The
technician ran for help and a team of doctors crowded into the
small room. There was nothing they could do. At 7:47 a.m., a Beth
Israel Deaconess anesthesiologist pronounced his former colleague
dead. Cambron was 35 years old.

Two months later, with his death still under investigation by the
police department, Cambron's friends and family don't know whether
he meant to kill himself or whether his overdose was accidental. He
left no suicide note, and he gave no signs that he was
contemplating such an act. Indeed, he had recently arranged his
apartment so that his girlfriend Yoh could move some of her things
in. But the empty bottle of vecuronium is a haunting goodbye. After
all, in spite of everything else that had gone wrong in his life,
Cambron was an excellent doctor. Some of those who knew him have a
hard time believing that he could have made such an elementary--and
catastrophic--medical mistake.

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