The term dovetail gets used a lot in the military—arguably to the point of overuse. I’ve never quite understood why it became such a default phrase, but in this case, it actually fits.

In my last post, I talked about how my circle of friends thinned out. I acknowledged that my situation may simply be more than some people can handle. I want to expand on that, because while the loss of friendships hurt, something else has hurt far more.

Friends, Distance, and Acceptance

Let me be clear: I do have good friends. Their actions show me that. They’re just not physically around, and that’s okay. People have their own lives, their own limits, and I don’t want anyone to feel like spending time with me is an obligation or some kind of hostage negotiation disguised as support.

At this point, I’m content with the people who are genuinely present in whatever capacity they can manage. I’ve made peace with that.

What I haven’t fully made peace with is the near-total disappearance of my professional community.

The Silence from Colleagues

The abandonment by professional colleagues has been far more painful than the thinning of friendships.

Outside of one colleague who has consistently shown support, most of the people I worked with in medicine have effectively vanished. In some cases, it was overt—like a former colleague literally crossing the street to avoid me. In others, it’s been the quieter kind of rejection: unanswered messages, polite but hollow interactions, silence where there used to be camaraderie.

A couple of months ago, I ended up in the emergency room. Walking into that facility felt surreal. The care was technically appropriate—curt, polite, efficient—but the warmth was gone. The concern I once felt as both a provider and a patient had evaporated.

I won’t sugarcoat it. It fucking hurt.

The Lie That Changed Everything

I have a few theories about why this happened, and the first is painfully obvious.

I lied.

I didn’t tell many of the providers I worked with that I had a substance-use problem. In some cases, these were people who later treated me. I can’t help but wonder if there’s now an underlying suspicion—If he lied about that, what else is he lying about?

I had to relearn a lesson I was taught years ago: you have to tell your provider everything. But even knowing that, I was deeply embarrassed. I was a professional. I “should have known better.” Admitting I overused substances felt like admitting failure on multiple levels.

That omission likely changed how some colleagues see me. Even those who are still friendly aren’t the same. The conversations are shorter, more guarded. Some of that may simply be distance—I’m no longer embedded in the same environment—but I don’t think it’s just that. Substance use has clearly reshaped those relationships.

Professional Distance and Passive Aggression

Beyond the lie, there’s another layer: professional distance.

At times, the aloofness has bordered on hostility. I get the sense that some providers worry that even talking to me is guilt by association. As if acknowledging my existence somehow implicates them.

Ironically, very few colleagues ever spent time at my home before any of this came to light. Yet now, the withdrawal feels absolute. When I do see providers, interactions are cold and purely clinical—terse, efficient, emotionally sterile.

If the goal is to make it clear that I’m not welcome, it’s working.

What bothers me most is the passive aggression. Medicine is oddly fond of it. Instead of saying, “I’m not comfortable seeing you anymore,” the preference seems to be emotional frostbite delivered one exam room at a time.

I would far rather be told directly that someone doesn’t want to treat me. Passive aggression is far more painful than honesty.

One Honest Conversation

My primary care provider and I did eventually talk—really talk. She was honest about feeling hurt, and she was right to feel that way. I should have told her. She reminded me that she had always been someone I could be open with.

The truth is, I hid my substance use because I didn’t know when disclosure would trigger mandatory reporting to licensing authorities.

In the end, it didn’t matter.

How It All Came Apart

Ironically, it was the same medical system—indirectly—that led to my professional downfall. A provider with secondhand information reported me to the state licensing authority.

I’ve had no contact with that person since, nor will I in the future. I have no forgiveness there. If you’re going to report someone professionally, maybe an actual intervention—while they were actively using—would have been more ethical.

But what’s done is done.

Thirty Years, One Defining Moment

What’s hardest to carry is this: after nearly 30 years in medicine, I am now defined by one incident—during a period when the world, my life, and my mental health were unraveling.

I was never “provider of the year,” but I was competent, consistent, and compassionate. I was sometimes investigated for being too blunt—but never found to be out of line. I was never written up. I received plenty of patient compliments and very few complaints.

Somewhere along the way, I learned why medicine prefers passive aggression: it protects people from risk. From being misunderstood. From being accused of misdeeds—like honesty.

Being direct was never a problem for my dog.
It was never a problem for my mom.

Being direct is better.

Being compassionate and understanding is essential.

And those two things should never be mutually exclusive.