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The pandemic…within the pandemic

2020 has been playing out like a real life version of Jumanji that whoever started….rrreeeaaaalllyyyy needs to finish.

We’re living in unprecedented times of medical, social, and economic upset; within all of this the healthcare industry has taken center stage in many aspects. The population as a whole has been given a glimpse into the daily lives of healthcare workers and seeing the emotional and physical toll working in the field can cause.

Recently, my heart broke to see the news that an ER physician (who was working with COVID-19 patients and had recently recovered herself from the novel virus) took her own life. Discussing this, and similar events, with people not in the medical field often elicits a great deal of confusion and disbelief.

“I don’t get it, I mean, she’s a doctor, how bad could her life be?”

Obviously with this case, and those like it, we will never know the full details of the situation leading to someone to take their life; and it is never a simple, unifactorial issue. Something that often shocks people is that healthcare workers (physicians in particular) have some of the highest suicide rates among all professions.

There are many suspected reasons for this; a high stress occupation, personality type, also knowledge of and access to more successful means. Another factor that I think plays one of the biggest roles is that they are rarely assessed or asked about this. It’s a strange phenomenon that even when these professionals are seeking mental health treatment the topic is often avoided by the treating provider. This may come from discomfort of the psychiatric provider being afraid he or she may offend the person seeking treatment, the assumption that the person seeking treatment would voluntarily offer the information, or maybe just being afraid to ask, because the provider doesn’t want to know the answer.

Many of the patients I treat work in the medical field themselves; from psychiatrists, surgeons, ER physicians, nurse practitioners, RNs, psychologists, etc. and I can tell you, just from personal experience, a large number of these individuals are seeking treatment for depression or severe anxiety, and the number of those individuals who have at some point seriously considered taking their own life is overwhelming.

One of the best snapshots of what working in healthcare can be like that I can think of comes from an episode of Scrubs. A young, new physician chastises his older, more experienced mentor for seeming callous and uncaring about a patient. The senior physician points to a room with a grieving family, the attending physician explaining their loved one had died. The family is visibly (and understandably upset), the doctor walks out of the room appearing defeated.  With a pained face, the senior physician points out, “You know what he’s going to do now? He’s going to go back to work. You think anyone else in that room is going back to work today?”

Over the last few weeks I’ve treated ER physicians whose faces are red, raw, and bruised from the constant friction of their N95 masks, psychologists and therapists who haven’t slept in days from the stress of trying to help walk patients through a global trauma they haven’t processed themselves, and nurses who have recently returned from volunteering in New York who have difficulty even describing the experience they just went through.

The current pandemic has taken an emotional toll on everyone, it’s an adjustment we’re all trying to navigate that has put unprecedented occupational, financial, and social strains on us all; and we all could probably use some additional support during this time.

There was just something about the news of Dr. Lorna Breen’s suicide that almost instantly made me tear up. Since at least the 70’s data has shown that every year, the number of physicians we lose to suicide is the equivalent of an entire medical school class (at a large medical school), or the equivalent of an entire small medical school. Similar statistics regarding nurses and other medical professionals aren’t as well recorded, but it’s not illogical to assume they would be at least somewhat comparable.

I raise the issue, not just because the story of Dr. Breen’s suicide got me right in the feels, but also that I think it’s an important reality check for our society as a whole. It seems like often there’s some kind of false belief that a pair of scrubs or white coat is some sort of armor for the person wearing it. It’s not. Behind the scrubs, the white coat, the stethoscope, the whatever… there is still a human being under all of this. This is a human who pays some amount of an emotional toll for every single patient they see.

A little-known secret outside of the medical world is exactly how competitive and cut-throat the field can be. It’s not surprising to hear of students sabotaging each other, pages getting ripped out of textbooks or reference materials in the library so other students don’t have access to them. Everyone feels pressure to prove themselves, to show that they’re good enough. This often leads to taking more shifts, working longer hours, taking more responsibilities, and maybe even being penalized, or scrutinized for not doing so. Someone expressing this struggle may even be seen as “just not being able to handle the pressure of the job.”

I think now, more than ever, we need a simple call to action: We owe each other better than this. It’s important to realize and remember that healthcare professionals experience a lot of trauma, whether it’s first or secondhand; and we are not immune from the neurological responses humans are programmed to have in response to traumas.

The message I really want people (healthcare providers in particular) to hear is this:

Don’t deny your colleague the treatment and help they need and deserve because of discomfort you may have. Ask the questions. There are so many ways you can broach the subject in a session. Even validating the stressors someone is having, and asking, “Wow, it sounds like there’s a lot of overwhelming things you’re dealing with. Does it ever feel like it’s all too much?” can be an effective way to transition into the subject.

The next would be asking for help, or admitting you’re struggling is not weakness. It means you are human. It doesn’t mean you ‘can’t handle’ your job. It doesn’t mean ‘something’s wrong with you.’ And maybe most importantly, you. are. not. alone. That unshakable façade you put on every day? A HUGE amount of your peers are doing exactly the same thing; not wanting to show ‘weakness.’

As healthcare providers, let’s lead the way in breaking down the mental health stigma, and start taking care of each other.

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