Sometimes it takes an extreme example to bring to light the grueling demands that we in the medical profession gradually accept over time -- demands that can ultimately lead to our own demise. The death of my dear friend, was one such example as she battled COVID-19 both as a patient and frontline physician, and as the clinical director of the emergency room at NewYork-Presbyterian Allen Hospital, ultimately taking her own life.
There is no doubt that as physicians and healthcare providers, we take an oath to care for those who are ill and to relieve suffering. We put our emotions aside to care for very sick patients and to be able to move on to the next in need. This is something Lorna did seamlessly in her emergency medicine career, with integrity and strength, but the physical and psychological demands of the COVID era are incomparable to anything we have seen before in medicine and warrant a moment of pause before we lose more of our frontline.
Breen was not just a hero in the field of medicine, practicing as what I would call a "bad-ass" ER doc who could handle anything, but a hero in so many other ways. She was a Renaissance woman who regularly played cello, snowboarded, danced salsa, and traveled the world (all while earning her MBA and working full time), serving as an inspiration to many other women. As a dedicated friend with an incredible moral compass, she always proceeded with what she believed to be right and just. She had an incredibly promising future and ability to impact the world, all of which ended too soon, leaving us to question why and where we could have intervened.
The COVID-19 epidemic came on abruptly and left many health systems ill-prepared. By most reports you'll hear, hospitals had adequate support and equipment to aid their providers, but knowing Lorna for many years, I think she would have wanted us to speak very honestly about the realities of practicing on the frontline in the epicenter of the pandemic. For many facilities, the ratio of nursing or medical staff to patients was inadequate, and the level of supervision required based on the acuity of illness was just not feasible. For others, the number of consecutive shifts without adequate time for physical and mental recuperation was unbearable. Most institutions planned for how limited resources for staff and patients (such as ventilators) would be rationed, and some had to actually face these morally impossible decisions. Couple these deficiencies with the fact that we are fighting a disease with no proven therapies, leaving physicians to practice with the deck stacked against them.
Let's also be honest about the fact that physician suicide is not new to the field of medicine and is amongst the highest of all professions, well before the coronavirus hit. Physician burnout has been tied to multiple aspects of the current medical system including workload, system issues, and even the personal characteristics of physicians themselves that perhaps attract them to the field -- self-criticism, over-commitment, and idealism. Physicians are often able to cope with bad outcomes and death when they are balanced by lives saved, but the persistent hardship seen with the COVID pandemic, however, has the ability to strip providers of a much-needed sentiment of hope.
Some of the circumstances of this pandemic could not have been avoided, but there is an opportunity now to revisit where we can lessen the blow to the psyche of the practicing frontline workers -- physicians, nurses, respiratory therapists, technologists, and many others -- to restore that hope. There are successful examples of how we can remedy the current and future state of medicine through camaraderie with other medical disciplines assisting on the frontlines, through a renewed research focus on the science behind this deadly yet fascinating disease, and through continued reminders of lives saved by our healthcare systems.
On Lorna's behalf, I ask all hospitals and division chiefs to review where they can provide additional staffing for required relief, to ask their staff about their well-being and need for psychological support, and to listen to the needs of their providers during this challenging time. For staff recovering from COVID-19, we should be mindful of the potential effects of the disease on one's mental state when the neurologic and psychologic effects are still not fully understood.
I also ask that we all check on each other, for as challenging as it may be to work on the frontline, I now understand that the psychological stress of isolation can be comparable. We must support each other and provide hope for the good that still exists in the world and is displayed daily in amazing acts of kindness.
Our emotional well-being must be preserved as fiercely as our physical well-being, so that we can together overcome this pandemic and strive for an even better state than we were at prior to COVID. We must reflect honestly and think creatively about how we can continue to refine our healthcare systems to run efficiently and effectively for both patients and healthcare providers.
It pains me to know that I was not there to support my friend during an exceptionally trying time and wish I had the chance to go back and change the outcome. I will now remind myself that even as Lorna was the epitome of resilience, ultimately, we are all human. The one thing that gives me daily solace, however, is the 7 p.m. roar from our strong-spirited New Yorkers who cheer in her honor, in her memory -- forever our hero, our role model, our friend.
The has been established in her memory to provide mental health support to healthcare providers.
, is the director of Women's Heart Health at Lenox Hill Hospital in New York City and director of Cardiovascular Prevention for Northwell Health.