What one doctor’s suicide taught us

Just over a month ago, I got a call at 10:30 at night from a doctor friend who works in one of the busiest emergency rooms in New York City. She'd just returned from a brutal shift, a miserable slog of impossible intubations and fruitless CPR. One patient, more or less her age, died just minutes after she'd placed him on a ventilator. She was so stunned she burst into tears.

My friend is not the type to burst into tears. She is generally a model of towering nerve.

A few days later, she went to one of the walk-in mental health forums at her hospital, expecting to see a large group. Instead, she had the psychiatrist and psychologist all to herself. In hindsight, maybe it made sense. As an emergency physician, she explained to me, "You're supposed to see things and move on." Project confidence and toughness; plough forward. It's the reason you're not reading my friend's name now. She knows what patients and colleagues expect.

In the months and years ahead, we're going to have to train ourselves to be especially attentive to the mental health needs of our first responders to this pandemic. In the aftermath of a disaster, they're at a far greater risk for post-traumatic stress, substance abuse and major depression than the average civilian. Yet seeing themselves as vulnerable is disruptive — antithetical, even — to their self-concept. They're the healers in this equation, not the ones who need to be healed.

It wasn't just my friend who taught this to me. Last week NBC ran an interview with the sister of Lorna M. Breen, the medical director of the emergency department at New York-Presbyterian Allen Hospital who died by suicide on April 26.

"I know my sister felt like she couldn't sit down," she said. "She couldn't stop working. And she certainly couldn't tell anybody she was struggling."

One wouldn't want to extrapolate too much from Breen's case. Suicides can be idiosyncratic, individual, painfully mysterious; the data on the incidence of suicide in frontline workers is mixed. But it ought to be noted that Breen was the second American health worker to die by suicide in this pandemic — the first was a 24-year-old Staten Island EMT, on April 24 — and she did not have a known history of depression or suicidal ideation.

Here are some facts about physicians that should put us all on notice. In general, doctors die by suicide at more than twice the rate of the general population, the highest of any profession. They also experience far more burnout. And the speciality with the highest levels of burnout? Emergency medicine.

Some of the reasons for this are guessable. Emergency room doctors work far more gruelling hours than most physicians and under more stressful circumstances, often seeing people on the very worst days of their lives. But when I phoned Dr. John R. Matheson, former president of the Washington state chapter of the American College of Emergency Physicians and founder of its Wellness Committee, he gave me a much more subtle, characterological explanation for why his subspecialty can be so depleting.

"We tend to be perfectionists," he said. "And disease processes aren't always straightforward. When you're a high achiever and you're very driven and you can't do what you want to do, it can be very disheartening."

Now introduce a novel, wantonly contagious virus into the already-chaotic emergency room, a virus that behaves in dumbfounding and pitiless ways. It's your problem to solve. But you haven't the tools to fix it — shift after shift, day after day, at a scale of suffering you've never witnessed. For people who are action-oriented and hellbent on finding solutions, this is a recipe for existential disaster. First responders are suffering from a crisis of utility.

"We're almost observers in this," Matheson said. "We can put patients on oxygen. We can intubate them in the ICU. But we're mainly trying to allow the body to heal on its own. Dealing with COVID largely means dealing with a feeling of helplessness."

Which explains my friend's distress that night. She told me point-blank that she felt like a failure. "There's no algorithm," she kept repeating. "There's no if-then."

But getting first responders to reckon with these feelings isn't easy. It's why my friend found herself alone with two therapists in a setting clearly intended for large groups. Last week, I phoned Dr. Craig L. Katz, a psychiatrist in the Mount Sinai Health System who's helping to organise their eight hospitals' mental health response for their workers. "It's been hard getting them to come to us," he told me. "We've had to go to them."

Dr. John Draper, the executive vice president of National Networks for Vibrant Emotional Health, told me that in the week after Sept. 11, their local New York City hotline, LifeNet, got more phone calls from health professionals offering to help than asking for it. That's how they cope. "And guess what?" he said. "We're hearing again from them now."

The solution, he said, may be that first responders find ways to counsel one another peer-to-peer, whether it's online or over the phone. They know what they need to hear. As for the rest of us: He suggests we refrain from platitudes about their heroism. "They're perfectionists," he said. "They're so aware of what they haven't done or aren't doing or might have missed. What's better is to say: 'I can only imagine how hard it is. I can only imagine it's a sacrifice.' "

For what it's worth, here's what helped my friend.

You were trying to help.

You did the right thing.

It was the disease. Not you.

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[If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK) or go to SpeakingOfSuicide.com/resources for a list of additional resources.]