The suicide of a doctor reminds us that the plague of COVID-19 creates deep emotional wounds in healthcare workers.
One of the oldest tales in the history of medicine is the story of the archetypal "wounded healer," Chiron. According to legend, Chiron, an immortal centaur, who taught medicine and served as a physician, attended a meeting organized by another centaur named Pholus. After a series of events involving other centaurs fighting over wine, Heracles (also known as Hercules), in his attempt to intervene, accidentally unleashed a poisoned arrow that struck Chiron's knee. Chiron, being immortal, was forced to endure excruciating pain.
Despite his ability to heal others, Chiron was unable to heal himself. Filled with shame, he withdrew to his cave, still committed to teaching his disciples. Finally, after nine days, his pain became unbearable and Chiron requested that Zeus remove his immortality so he could die. Although it is a myth, it serves as the first documented history of a medical suicide, albeit assisted, and suggests that the challenge of curing our healers dates back centuries.
The recent suicide of Lorna Breen, an accomplished and compassionate doctor, researcher, colleague, friend, sister, and daughter, after she served in front of a busy New York City emergency department, reminds us that the plague COVID-19 also creates deep emotional wounds in healthcare workers. As her father Philip Breen described her, she "was like the firefighter who meets the burning building to save another life and considers nothing of herself. His death was not due to COVID-19; it was due to a system and culture of hospital medicine that did not value her as human beyond her profession.
Right now, COVID-19 is a stress test exposing vulnerabilities in our health care, welfare, and financial systems. But it is also a catalyst, leading to novel solutions such as providing a guaranteed basic income, expanding blood donation eligibility, reducing red tape in hospitals, and encouraging partnerships between tech companies. As such, it must also be a catalyst for improving medical culture, such that one day no physician will be forced to choose suicide as a result of the inability to cope or seek healing for themselves.
Awareness of the suicide epidemic affecting the profession has gained ground in the last five years. Physicians have the highest suicide rate of any profession: about 300 physicians die each year in the United States (the size of a typical student body in a medical school). Indeed, suicide has now become an occupational hazard of the profession. But he is also the canary in a coal mine that serves as a warning to an overwhelmed and unhealthy system, which does not care about its doctors.
One thing is painfully clear: medical suicide is not about resistance. Doctors, by definition, are tough; we must jump many hoops to gain admission, take long night calls often without food, water, or sleep, and work irrational work hours, often with an inadequate support system. Unfortunately, the overemphasis on individual resilience at the expense of ensuring a healthy work environment has placed the responsibility on the doctors themselves, which is nothing more than blaming the victims.
While substance use and mental illness can be factors, many doctors do not have a mental health disorder diagnosed as depression and anxiety. This may be due, in part, to the stigma around seeking a formal diagnosis, but we also know that the symptoms of depression are highly environmentally dependent; The influence of our situation on our reactions has been understood by sociologists for decades.
While things like mindfulness help to some extent, it is a lot like waiting for a soldier to meditate while bombs are being dropped around him. Instead, the priority should be to get that soldier to a safe space with a battalion he can trust, with the proper protective gear. Putting a healthy person, someone who is driven, intelligent, empathetic, in an environment that is not conducive to their well-being will put additional pressures on them with little room to thrive, or possibly even survive. The consequences can be disastrous, but they are not surprising.
The problem of medical suicide is so deep, and the role of culture is so important, that pontificating on solutions often feels pointless, especially since the problem is not so much what the solutions are, but how to update them.
Culture must change from the top down, and this requires strong policies and commitment. Policies should include limits on work hours, time for self-care, and zero tolerance for bullying and harassment. We must also increase psychological safety (defined by Harvard scholar Amy Edmondson as "a climate in which people feel comfortable expressing themselves and being themselves"), an issue that is a pressing problem during the pandemic, such as with layoffs. of physicians in Mississippi who have expressed their concerns.
We must also ensure that all physician health programs are free of conflicts of interest, completely divorced from licensing agencies, and accessible both geographically and financially. Especially during a crisis, as we know from aid workers, re-entry trauma is common, so access to these programs is now paramount to offset the risk of suffering alone. Isolation is an unsafe breeding ground for trauma, anxiety, and unprocessed pain.
Beyond telling the story of Chiron's death, the ancient Greeks came to see suicide primarily due to faulty "humors", the end result of the accumulation of black bile (melancholy) or yellow bile (mania). The beauty of medical knowledge is that it evolves; so too must our understanding. We must take lessons from Chiron, and as recently as Lorna Breen, to understand that environmental factors matter far more than the individual. Breen's passing during this pandemic offers us a moment to reflect on how best to use our outrage and mourning, as patients and doctors, to finally emerge from the clouds of ignorance, willful blindness and institutional inertia to avoid the same tragedy from repeating .
Once Chiron died, he left two legacies. The first was in those he taught: such as the father of medicine, Asclepius, who in turn was said to have taught Hippocrates. Thousands of medical students take the Hippocratic Oath each year. The second legacy, according to the poet Ovid, was through a gift from Zeus, who wanted to make sure that Chiron's spirit lived in the night sky, so he created the constellation Centaurus, which can now be seen as a literal interpretation from the saying by aspera. ad astra ("through difficulties, to the stars").
It shines brightest during the month of May. This year could remind us of the thousands of doctors who took their lives while healing others, some during this pandemic, doctors who could inspire us to finally change direction. And for Breen, as one of those shining stars, we can also swear to honor you as the hero you were, lighting our way forward.