Treatment for endocarditis usually involves up to six weeks of intravenous antibiotics, often in the hospital because doctors are wary of sending addicted patients home with IV lines for fear they would use them to inject illicit drugs. Many, like Ms. Whitefield, also need intricate surgery to repair or replace damaged heart valves. The cost can easily top $150,000, Dr. Pollard said.
Advice from specialty groups, like the American Association for Thoracic Surgery and the American College of Cardiology, about when to operate remains vague. For now, “it’s just a lot of anecdote — surgeons talking to each other, trying to determine when we should and when we shouldn’t,” said Dr. Carlo Martinez, who is one of Dr. Pollard’s partners and who operated on Ms. Whitefield at Methodist Medical Center of Oak Ridge.
Their practice, owned by Covenant Health, will almost always operate on someone with a first-time case of endocarditis from injecting drugs, Dr. Pollard said. But repeat infections, when the damage can be more extensive and harder to fix, make it a tougher call. Dr. Mark Browne, Covenant’s senior vice president and chief medical officer, said, “Each patient is evaluated individually and decisions regarding the appropriate course of care are determined by their attending physician.”
In the nearly two years since she got sick, Ms. Whitefield has felt physically diminished and been prone to illness. She also feels harshly judged by a medical system that saved her life but often treats her with suspicion and disdain.
Over the same stretch of time, Dr. Pollard has grown increasingly disillusioned with hospitals that consider addiction treatment beyond their purview, and haunted by the likelihood that many of his drug-addicted patients will die young whether they get heart surgery or not. He set up a task force in 2016 to address the problem but has faced obstacles, especially concerning cost and, he believes, a societal reluctance to spend money on people who abuse drugs.
“Everybody has sympathy for babies and children,” he said. “No one wants to help the adult drug addict because the thought is they did this to themselves.”
Ms. Whitefield, a talkative young woman with brooding eyes, goes by the nickname Shae. She started on opioid painkillers as a teenager suffering from endometriosis, a disorder of the uterine tissue, and interstitial cystitis, a painful bladder condition. She got the opioids from doctors for years, and eventually from friends.
She and her high school boyfriend, Chris Bunch, had three children by the time she was 26. She trained to become a licensed practical nurse but dropped out of the program when her oldest son, Jayden, got seriously ill as a baby. The family lives in a tiny town that Mr. Bunch, now Ms. Whitefield’s husband, described as “country, country, country.”
In 2015, after their daughter, Kyzia, was born, Ms. Whitefield sank into postpartum depression. She was obsessively worried about shielding Kyzia from sexual abuse and other traumas she had experienced as a child. She started injecting crushed opioid pills and occasionally meth, savoring the needle’s sting — she had an old habit of cutting herself to provide relief from emotional pain — at least as much as the high.
After sharing a needle with one of her brothers that day in June 2016, Ms. Whitefield started shivering and sweating. A fever soon followed, and she lay for almost a week on the couch, thinking she had a kidney infection. She was delirious by the time Jayden, then 8, woke her stepfather one morning and told him to call 911.