In the depths of her relapsed addiction, Debbie said she was injecting 15 milligrams of Dilaudid, a narcotic eight times more potent than morphine, into herself. The normal adult oral dosage of Dilaudid is up to 10 milligrams. The injected dose is even smaller, about 1.3 milligrams.
"The unfortunate thing is that 10 to 20 percent of addicts in medicine will actually present dead," said Fitzsimons. "They're found dead in the call room or at home because they utilize these substances, not appreciating the potency."
And providing medical care under the influence of a drug can jeopardize patients.
"No patient should ever accept the care of a person under influence," Fitzsimons said.
But often, those who are addicted remain high functioning, and colleagues may not know until the addiction becomes very severe that anything is wrong.
Her addiction was not fatal, but Debbie did resort to stealing from her workplace to support her addiction. And as her behavior changed, her colleagues began to notice her problem.
"I never ever thought the day would come that I would one day relapse and jeopardize my profession. That I would find myself in a position where drugs were available and I would take them," Debbie said. "And it did come."
After an anonymous call was made to the hospital director, Debbie was pulled away from her duties, given a drug test, which she failed, and was fired.
"That's the same thing a cocaine or heroin addict does when they're addicted -- break into homes and cars," Brooks said. "But it's not so much about the individual as the disease [of addiction]. And they usually get caught."
After losing her job, Debbie felt shame and remorse and sank into a depression that eventually culminated in a suicide attempt. Still, she chose to receive treatment and eventually returned to nursing, though not, she decided, at her old job because of the temptations there.
"I had to remove myself from that environment and get to a safe place," Debbie said. "I know in my heart of hearts that I can't use any mind-mood-altering substances. The stimulus just starts the craving phenomenon."
The anonymous call that probably saved Debbie's life may not have been possible 20 years ago, according to Brooks.
"There used to be a code of silence among medical personnel... and meant to be protective for the person who's using, but it's a reverse protection," he said. "Now, the air is more that people are alert to this and the consequences are greater and we are rapid to identify and intervene in the problem."