Thursday, April 30, 2015

The Doctor's Dead

A patient in a chemotherapy hospital ward looked forward to the regular therapy sessions with her therapist who always brought laughter, a ready hug when needed and inserted more than a ray of sunshine in an otherwise taxing stay. Despite the diagnosis and the possibility of a shortened life, the patient somehow felt that everything could be okay if she stayed positive and had this wonderful therapist as a guide in her life's journey. It was comforting and she was always there when needed.

After the patient left when her series of treatments were completed and she found herself once again at home, involved in life and striving to stay healthy, she decided another "touch-up" session would be a good thing. Calling the office for an appointment always seemed like such a natural thing and there was no apprehension about a session. Other patients weren't quite so sanguine in their approach to sessions, she knew, but this therapist was willing to work outside the lines. The hug, for instance, would never be acceptable to a more traditional therapist and laughter and joking usually wasn't the stuff of sessions, either. But not here. This was a place of more than therapy. There was an unspoken kinship.

The phone rang several times and then the connection was made. "I'd like to make an appointment," she fairly chirped. Silence. Not good, the patient, thought for one brief moment and then she heard the words she'd never expected. "I'm sorry, but the doctor died." The thud she felt was like a hammer to the heart. Dead? How could such a vibrant, joyful woman be dead? Accident? Sudden horrific illness? What?

Slowly, she explained how long she had seen the therapist and the woman on the other end understood. The therapist, she soon learned, was, throughout all those wonderful and enlivening sessions, fighting her own cancer battle and cancer had won. Obviously, there was a demarcation line even in these sessions and the therapist's impending death was not to be discussed or even hinted at. Anger could have been her reaction, but that would have negated and minimized the therapist's own sacrifice in the service she provided to this patient. The sessions were to address the needs of the patient, not the therapist.

How many of the healthcare professionals who treat us are struggling with their own illnesses or demons that will remain unknown to us? The statistics concerning physician deaths by suicide may provide a window for us. And the stats are eyeopening.

Every year, we're told, 400 physicians commit suicide and it's often a hidden statistic because obituaries and short death biographies in the journals often decidedly omit suicide as the reason for death. In some cases, it may be insurance considerations, but more likely there's a reluctance on the part of the medical community to shine a light on this topic. Better to keep the family safe from the shame of suicide, I suspect, is their main motive and to present the person in a favorable light.

The topic has come home to me in a rather circuitous manner.  Querying a physician, about a specific medical procedure, I was told that there was a superior physician who could have provided the treatment but he had died. How, I asked? A few moments of thinking and the physician told me, "It was suicide." When I returned home, I immediately did a Google search and read the local newspaper account of this brilliant man's life and ultimate death outside his home, in the snow. Suicide was the cause, but how he did it was left out.

What had driven him to this? As I did more research, I discovered that he not only pioneered a specific procedure, but he taught internationally, had recently opened a hospital in another country, remarried and was preparing for some major changes in his life. Still relatively young, he had years left to utilize his skills for the benefit of others. What happened? No one will ever know because the town newspaper was the only source with that one article. The gates of secrecy had closed forever on this man and his final departure from medicine.

Burnout in physicians is too often shrugged off as the mind-numbing workload and impossible brutality and bullying of senior staff (particularly of interns and residents) is seen as a weeding out process and nothing more. If that's so, I guess the two talented men who had just begun their residences in prestigious New York City hospitals and who had killed themselves, weren't able to cut the mustard. Wimps, perhaps? How callous of anyone to even think that.

The burnout rate in medical students has been estimated to be about 50% by graduation. What happens to burned out medical students? Many of them will continue on to complete their degrees, but how do they manage that? Some, as the young woman found dead in a major NYC hospital stairwell (she was featured on the school's admissions brochure), will use easily available drugs to keep up the pace and avoid sleep as well as tolerating the continuous bad behavior of house staff and attendings. I recall one student telling me that, while observing a surgery and standing on a small stool to view the procedure, the surgeon wheeled around and kicked the stool out from under her. A nurse saved her from falling on the instrument tray. Another told me that he returned home each day from medical school in tears because of the dreadful day he's just had. Every day.

Depression is found in physicians just as it is in the general population. In fact, 12% of males and 18% of female physicians suffer from it. What about medical students, interns and residents?  Once serious, deep and chronic depression fails to remit,  physicians are much more successful at suicide because of their knowledge of lethal methods. Is admitting to depression discouraged and even looked down on by members of the profession? Probably and there could even be the concern that it will damage a career or put an end to one that is just beginning.

Such a concern appears to match up very well with the military where help may be available but requesting it may lead to short-circuiting career advancement. Then, of course, there's impairment brought on by medication should that be needed. Who wants a surgeon with any cognitive impairment brought on by medication to operate in their hospital or on their patients?

Medicine, despite what many people might think, is not such a great field to pursue as a career, even if you do manage to jump through all the hoops needed to just get into medical school. Things have only gone downhill as more and more paperwork is required and office staffs are stretched and everyone from student to physician is required to do more in the same amount of time--a time that is often extended by lack of sleep.

Where are physicians heading and why are we experiencing a dire need for increased numbers of physicians in this country? They are opting out of medicine, retiring early and looking at sites like D.O.C. (the Drop Out Club) that offers entree into another field where they can use their medical expertise out of a medical setting.

Failure to enlighten all those in the field about suicide potential and burnout insures a ready supply of physician-related obits and young docs jumping off buildings or overdosing in hospital stairwells. Just imagine yourself in a situation of constantly being expected to provide all the answers to health-related problems without anyone ever recognizing your needs. It's more than overwhelming. When medicine has the highest rate of suicide, something is wrong and something must be done.

Physicians begin to heal thyself as a profession or we all suffer.

http://www.drfarrell.net