I have been thinking a lot about Dr. Lorna Breen

Dr. Lorna Breen, an ER physician in New York City, killed herself after working the front lines in the pandemic.  Her death has created a call to action.  The headlines read that healthcare workers are suffering; they are heroes; they need support.  Dr. Lorna Breen was 49 years old.  I am 49 years old.  I am also a successful ER physician on the front lines of the pandemic.  I can’t speak to Dr. Breen’s experience.  But I can tell you mine.

Most of us who work in the ER signed up to work with the most emotionally challenging patients in medicine because we “fill our buckets” by connecting with people in the most difficult moments of their lives.  We are the cops of medicine.  We take care of the homeless, drug addicts, car wrecks, cancer patients, heart attacks, the dying.  We love it.  We are a unique bunch.  We are achievers, A + students; we get the job done, weekends, holidays, overnights. But we are also the healthcare workers that need to achieve the most outside of work because we are constantly humbled by what we cannot do in our professional lives.  We cannot fix that the mother we “heroically” resuscitated after her car accident may never recover from the deaths of her two children who we could not save.  We cannot fix that the child we “saved” from drowning will need 24-hour care for the rest of her life.  We cope by holding the mother’s hand of a dying child. We cope by talking a family through a parent’s death.  We cope by knowing that by being fully present, by really seeing and acknowledging our patients and their family’s pain, what we do matters.  But this is different.

First of all, I can’t breathe.  PPE.  Personal protective equipment.  It starts with an N95 mask.  The mask is thick and fits tight to my face.  The rubber bands cut off the circulation to my ears, but if I touch it, I will get COVID.  For an 8 hour shift, I suffocate.  On top of the mask, I wear a face shield, which is essentially a welder’s mask.  This needs to be cleaned multiple times a shift with a solution that smells like urine.  It is incredibly hard to concentrate much less truly connect with patients.

Still, I signed up for this.  The morning news feeds me I am a hero, a hero, who last week, walked into a room of a patient with dementia and after seeing me in my spacesuit, curled up in a ball and started screaming.  I wasn’t human.  The N95 mask makes it hard for even those patients with the best hearing to understand me.  If English is a patient’s second language, or the patient has difficulty hearing communication is almost impossible.  No one can see my eyes or facial expression.  Body language, facial expression, having a conversation, that is how I connect with my patients.  I cannot connect.

I have seen an enormous number of patients with mental health crises.  I have seen multiple patients who have attempted suicide. Not just by our usual attempts, suicide by overdose of drugs or alcohol, but patients who were stopped by a passerby from jumping off a bridge or putting a bullet in their head.  I have seen more anxiety than ever before.  Patients who have never had a panic attack but present to the ER desperate for some relief.  Patients without their anxiety or depression medication because their usual physician was furloughed or unable to see them in person.  All of them had one thing in common, a desperate need for human connection.

This week I have seen many patients die of COVID-19.  All of them had a story.  All of them were heroes.  Before COVID-19, they would have died with their families around them; their lives would have been celebrated with a funeral, they would have been more than the department of health’s daily update.  They would not have spent the past six weeks socially isolated.  They would not have died alone.

Dr. Breen worked in New York City.  She would have seen death on a scale that thankfully, I have not.  Dr. Breen was a hero, not because she was an ER physician, but because by all accounts, she was an amazing human being.    And like all those that have and will die from or because of COVID-19 her life deserves to be honored.  I can’t tell you why Dr. Breen killed herself, but I can tell you that she was a witness.   A witness to the incredible power of a string of RNA that is COVID-19.  A witness to fear.  A witness to helplessness and disbelief.  A witness to child and domestic abuse on a scale never seen before.  A witness to the depression, anxiety, and isolation.  A witness to those who grieve the deaths of their parents in ER parking lots, on Facetime, on Zoom without the support of their friends and family.  A witness to the loss of the last hug, kiss, touch of those we love.  A witness to the death of hundreds of COVID-19 patients who died in isolation, with only an emergency physician in an N95 mask, a gown and a welders shield, who spoke to them on a phone outside the room,  a doctor they had never met, could not see, could barely hear, who promised to tell their children they love them.  A witness to the most powerful social experiment ever performed.  A witness to our response to COVID-19.  Thank you, Dr. Breen, for caring so much.

Carolyn Anne McClain is an emergency physician.

Image credit: Shutterstock.com

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