Dr. Lorna Breen, who died by suicide on April 26, was the canary in the coal mine. You can see it in her eyes, and in her smile. I didn’t know her, but I’ll bet she sang. One of her causes was successful communication with autistic patients, something beyond most emergency physicians. She was a leader in a profession and a specialty already reeling under the occupational syndrome of moral injury that is dismissively labeled “burnout,” too often mistakenly deemed to be a personal inadequacy rather than what it really is: a massive organizational failure. EPs are the only physicians willing to treat any patient in any condition at any hour of any day and without regard to the patient’s ability to pay. We love nothing more than to be of service to those in their hour of greatest need, take our sustenance, and gain energy from our well-honed ability to intervene in any type of crisis — especially in any type of patient to those who are denied access by others. And we do this to save lives and to alleviate suffering. And where even that is not possible, to dispense care and compassion to the patients, family, and survivors. Like all of her EM colleagues across the country and around the world, Dr. Breen was only too happy to serve during one of, if not the most, frightening event of our lifetime. Many outlets have revealed the horrific conditions in NYC hospitals similar to those Breen served in. Many sources have reported hospitals (or contract management groups at their behest) having penalized, through discipline or actual firing, frontline providers attempting to better the care of their patients through direct appeals to the public to help secure PPE and other needed assistance. Working with inadequate personal safety protection, going without food, drink or bathroom breaks for hours because of the relentless crush of patients; witnessing the suffering and deaths of too many simultaneously; having to enforce well-founded but painful institutional regulations separating families from their loved ones and then attempting to be the go-between for final, electronic good-byes, all the while worrying about the other patients who may be arriving near-death or crashing, about your own safety, about that of your colleagues and co-workers, and of your own family to whom you wish and need to return for periodic renewal, but can’t: these, for frontline providers, are conditions that rival any poorly regulated coal mine. Add to this picture actually contracting and emerging from the infection, which has already killed many of your colleagues around the world. Survivor guilt kicks in on top of concern that your absence caused others to have to work extra shifts. “Why me?” I must go back and work harder to try to keep others safe would be the self message of a compassionate provider, especially one in leadership. Those on the front lines of the pandemic in China, especially women, fared poorly with the emotional outfall of dealing with pandemic patients. What is not well known is that having SARS related or COVID infection can cause neuropsychologic and neurocognitive effects (affecting emotions, thought, and reasoning). We have no idea how often this may happen, or how long it lasts. Imagine being a general returning to the front lines to rally and invigorate your troops after an injury, and finding that you can’t think as clearly or as quickly as you could before the illness. Then realizing that, for the safety of others, you must withdraw temporarily and do nothing but worry — not knowing whether this condition is temporary or permanent. Just fearing that you may never be able to sing, fly or lead again. The report that Dr. Breen died by firearm, an extreme rarity in women physicians (and perhaps especially female EPs), is a testament to the anguish, confusion, and despair she must have suffered. Lorna Breen was the canary in the coal mine. Uniquely herself, but a sibling to all the other canaries attempting to shore up a failing system that was not prepared to protect us against carbon monoxide, let alone implosion. Sadly, before this is over, we will predictably lose many more heroic canaries. We will inevitably have far fewer sentient, talented and selfless providers still willing to make up for the deficits of a system that does not provide even pit props (the struts that hold up mine walls and ceilings), or other protections. Not even resuscitation stations for the noxious “damps” (gasses that accumulate and kill miners, especially carbon monoxide) permeate the system. More than a few health care providers at many levels have announced in various outlets, “After this is over, I’m done.” Their spirits may have already departed. Can we yet recapture them? Louise B. Andrew is an emergency physician and can be reached at Black-Bile. Source
