How the Opioid Epidemic Changed My Life

This is a web exclusive from our upcoming issue Why Be Healthy? In an age of health care and wellness industries and near-religious pursuit of fitness and self-optimization, this issue asks what it means to live well despite the limitations and frailties of our bodies, and what, beyond the scope of medicine, is needed for our flourishing.

Tom Andrew started out as a pediatrician but became a forensic pathologist, initially serving the City of New York before being appointed Chief Medical Examiner for the State of New Hampshire. When he had been serving in this role for fifteen years, the opioid epidemic exploded in New England. Overwhelmed and disturbed by the increasing number of young bodies that showed up in his morgue, he began to consider the root causes of substance abuse and ended up going to seminary. He is now working with young people again, this time as a chaplain for the Daniel Webster Council of Scouting America. Reuben Zimmerman inteviewed him for Plough about what he’s seen.

Reuben Zimmerman: You started as a pediatrician in Cincinnati and worked in that field for several years. Why did you move into forensic pathology? And how are the two fields even related?

Dr. Tom Andrew: From the outside looking in, these fields could not seem further apart. But for me, the transition felt quite natural. I was committed to pediatrics and immensely enjoyed my experience at Cincinnati Children’s Hospital. Still, I never forgot the fascinating series of pathology lectures in my second year of medical school, and was especially enthralled by the lectures of Charles Hirsch, who eventually became my professional mentor. And once in private practice as a pediatrician, the cases that most caught my attention were those that interfaced with forensic medicine: child abuse and neglect, sudden infant death, and consumer product safety issues. I eventually left pediatrics, pursued a second residency in anatomic pathology, and ended up doing a fellowship with Dr. Hirsch – who by now had become Chief Medical Examiner of the City of New York. As a result of this training I have been able to carve out a niche for myself as a go-to person in forensic cases that involve infants and children.

You worked in the Office of the Chief Medical Examiner of the City of New York, in Manhattan, Brooklyn, and Staten Island. What was that like? There must have been many bodies and many stories. How did this work shape you, as a doctor and as a believer?

I arrived in New York City just after we had reached a peak in the annual number of homicides, pushed over the 2,000 mark by the Happy Land club arson fire in the Bronx. That was 1990, and the fire killed eighty-seven people. Homicides have declined every year since then, but we were still very busy: besides homicides, which comprise only twenty percent of the caseload, there are still plenty of natural deaths that trigger a response by the medical examiner’s office, not to mention accidents and suicides.

It would have been quite easy to become cynical and despairing, but Dr. Hirsch always insisted on respect for the dead, and approached their examination with a sense of dignity and reverence for life. He took to heart an article by one of his own mentors, Lester Adleson of Cleveland, who suggested that the forensic pathologist is a “family physician to the bereaved.” Through this lens, I could begin to see my work as a type of ministry.

At the same time, my faith was being nurtured by Trudy Codd at St. Mark’s United Methodist in Staten Island, and as part of my professional development, I had also joined the National Association of Medical Examiners and begun to attend their annual meetings. Ours is a small subspecialty: in any given year, there are fewer than five hundred full-time practitioners of forensic pathology in the entire country. Joining this group led to a work of God I could not have predicted: to my amazement, I encountered a far higher percentage of believers in forensic pathology than I had ever encountered in pediatrics.

I believe that it’s because of what we see, day in and day out. The scenes that play over and over in our heads present fertile ground for the Holy Spirit to open one’s mind to the sanctity of life, the problem of evil, and the extent to which so many people walk in utter darkness – as John Wesley would say. This fertile ground produced a chaplain from the seed that was forensic pathology.

You then moved to New England, becoming Chief Medical Examiner for the State of New Hampshire. In that role you were probably one of the first people to see the early ravages of the opioid epidemic. When did you realize that this was becoming a major problem? And how did it affect you personally?

After six years in New York, my wife, Becky (who is a psychiatrist), and I realized we did not want to raise our family in the city. We had two small children and a third on the way. I was blessed to be appointed as Chief Medical Examiner in New Hampshire in 1997. The Granite State turned out to be an ideal setting for our family and all three children are now dyed-in-the wool New Englanders.

In 1998, like every year before it, there were fewer than fifty drug deaths in New Hampshire. But by 2002 there were over one hundred, and by 2005 we were one of the first jurisdictions in the country to see drug deaths exceeding traffic deaths. That was driven mostly by methadone and oxycodone. By 2011, annual drug deaths had reached two hundred and we were finally plugged into the gravity of the situation. Methadone and oxycodone gave way to heroin, a street drug that had not been prominent since the 1960s. Our office tried to get in front of the problem, framing it as a public health emergency, but we were mostly ignored by the media, policymakers, and the public. After all, this problem only affected “those people.” I’ll never forget the voice of a legislator from an affluent district who said, dripping with condescension, “We don’t have a drug problem here.” Little did she know.

Then came fentanyl and its very potent analogues and we were in a full-fledged crisis. It took just three more years to reach three hundred deaths and one year later, in 2015, we topped four hundred. It was this exponential surge, fueled by fentanyl, that brought me to the point of questioning. Was I giving anything of value back to my community by just counting the bodies? The two opposite ends of the public health spectrum are prevention and assessment, and after having spent so many years on the assessment end, I began to give serious thought to what I could do on the other. This, along with my long-term link to Scouting and a call to vocational ministry, provided the foundation for yet another career shift.

As a medical examiner, your patients are unusual in that they are already deceased. You once told the New York Times that you found it impossible not to ponder the spiritual dimensions of what you were seeing – certainly for the deceased, but even more so, for those left behind. How did you deal with the weight that must have been on your mind and heart? And what kind of interactions did you have with the family members of the many young people whose lives had been cut short by drug overdoses?

Dr. Hirsch taught me the importance of making a phone call to the family of the deceased after the gross autopsy was completed. You might not have all the answers at that early stage, but he felt strongly that families are still owed professional attention amidst what is likely the worst experience of their life. I continued that practice in New Hampshire, and it was through those thousands of phone calls that I came to view things through a chaplain’s lens. Drug deaths are in a class of their own – the results of testing take weeks to come back – but the long battle the family has fought together with their loved one (often their child) mostly makes the specific results relatively unimportant. Many times, these calls proved to be times when families could tell me what wonderful, caring, and vibrant people the deceased had been, before addiction dragged them down. At other times there was rage – vehement, unfocused rage at the drug dealer, the friends of the deceased, the police, the “system,” and even me as a representative of that system sent to “cut up” their loved ones. It was in this crucible that I tried to develop the practice of nonjudgmental presence, being a listening post and, when feasible, a voice of encouragement.

Faith very rarely came up in these conversations, and being in the public sector, I had to be cautious about going there, but when there were openings, believers who had tragically lost loved ones were often more of a blessing to me than I was to them. I will never forget making the call to the father of a seven-year-old boy who had collapsed and died while playing with his friends. Unlike the majority of cases like this, the gross autopsy yielded the cause of death: an anomalous coronary artery. I explained the cause, expressed my condolences – and then the boy’s father asked me how I was doing! I knew at once I was speaking with a believer, and the rest of our brief conversation reflected that. It took me quite a while to regain my composure and move on to the next case that day.

Photograph by Cavan Images / Alamy Stock Photo.

I’m interested in your spiritual background. Have your perspectives and beliefs been changed or challenged by the enormous number of tragedies you have personally witnessed?

I was raised in the Presbyterian Church in Dayton, Ohio, and the value of that youthful spiritual formation cannot be underestimated. I attribute that to my parents, but also to my Sunday school teachers and my childhood pastor. But it was not just the church: my Scout troop in East Dayton was chartered by a Methodist church, and the young and energetic pastor who steered us through the “Duty to God” badge requirements was equally influential.

My faith grew cold in medical school. I put all my energy into academic success, and life was all about me; I became egotistical and lonely. But God wasn’t ready to let me go, and by the time I was in residency at Cincinnati Children’s, I had become close with two committed Christians, family men who were grounded and mature. My wife was a help, too, and pushed for us to join a church after we had moved to New York.

Faith has been an anchor for me, and I shudder to think of what my self-absorbed life would have devolved into had it not been renewed, spurred along by fellow physicians, my wife, and my church family.

Many people today contend that drug addiction is a medical illness. While there is something to this, how does personal responsibility and choice factor in? How do we equip young people to make good choices?

Even if one concedes the idea of some kind of genetic vulnerability to addiction, we are still graced with free will: we can, in fact, accept or decline that first illicit substance, and even after we’ve been caught in the trap of addiction, we can still choose a path to recovery. Stating this may seem callous, especially to those whose addiction was initiated by prescribed medication, or to those who are self-medicating their despair. But it is the sequence of everyday choices (even over years!) that either keeps us in evil’s grasp, or frees us from it.

We read that our enemy the devil prowls around like a roaring lion, looking for souls to devour (1 Pet. 5:8). Youth without any foundation or guardrails will be easy prey; those armed with timeless and biblical values may be better equipped to fend off the enticements that so quickly lead to disaster. Of course this isn’t failsafe. But I am convinced that youth ministry makes clearer the pathway to freedom that a godly life provides.

You eventually stepped down from your medical examiner’s post and decided to go back to school – to enter the ministry. How and why did that happen?

I know two others who followed this path, actually – as I told you, forensic pathology seems to produce believers! By 2015, I was already looking for an exit from medicine, and providentially, I was asked to chair the Duty to God / Religious Relations committee by our local Scouting Council. I had already been active in Scouting in my youth and plugged in again when my own boys became Scouts; I eventually became Scoutmaster of our local troop. Serving in this role was the impetus for the formation of my personal ministry. I now serve as Protestant Chaplain for New Hampshire, providing invocations, benedictions, and worship at various events. I also serve individual Scouts, teaching the religious emblem class. My favorite activity, though, is serving as chaplain at summer camp.

Youth ministry in the cathedral of the great outdoors instills values that remain with young people throughout their lives, and just may be the difference that allows them to say no to that first offer of an illicit substance. It’s impossible to measure the results of prevention efforts, but I am convinced that Scouting can play an important part as we push back against the evil that is substance abuse. In this way, my work has come full circle.