In April 2020, Dr Lorna M. Breen, 49, an emergency room physician at New York-Presbyterian Allen Hospital in upper Manhattan, called her sister Jennifer Feist, who lives in Virginia. As per a July 11, 2020, article in The New York Times, Breen was an overachiever in every level of her career, and was managing one of the busiest emergency rooms in New York City. That week in April, New York reported the highest number of fatalities from Covid-19. Large hospital systems and emergency rooms were overrun by patients seeking help with severe infection, low oxygen levels and high fever. The emergency department Breen had been managing was not an exception.
Doctors and nurses were asked to make decisions about who will get a ventilator or an ICU bed, which amounts to decisions about who will live and who will die. The death and suffering they witnessed during the tsunami of this pandemic was unimaginable. In addition, there was confusion about the management of Covid-19, its complications and the lack of specific treatments or PPE to protect themselves from the infection.
Breen did not know where to turn and she called Jennifer, who picked her up from New York City and helped to get her admitted to an inpatient psychiatric ward at University of Virginia Medical Center. In a few weeks, she was discharged and was staying with her mother. On April 26, Breen took her own life.
Unfortunately, Breen is not alone. Doctors and nurses have two times higher risk of committing suicide than the general population. Uncontrollable health care crises like Covid-19 have exacerbated that and brought it to the public’s attention. One of the first ‘Covid suicide’ cases in the Indian medical fraternity was of Dr M. Kannan, a postgraduate resident in the orthopaedic surgery department of Stanley Medical College, Chennai. He jumped from the third floor of his hostel in July 2020. As per news reports, he was taking care of Covid-19 patients until a few hours prior to his death.
As a doctor and leader in a large cancer centre, I witnessed this crisis unfolding first-hand. It was early 2020, when there was confusion and misinformation about mask-wearing. Data was still being collected about the efficacy of masks in preventing the spread of the virus, and colleagues were conflicted. I will never forget a call I received from a colleague one night. “Dr Abraham, I have sick parents at home and I need to protect them,” he said. “I just want to make sure that I am not bringing Covid home.”
The signs and symptoms of burnout we witnessed were alarming. Dr Amy Sullivan, director of behavioural medicine at the Mellen Center for Multiple Sclerosis Treatment and Research at Cleveland Clinic, says that “burnout is about a low sense of accomplishment, loss of meaning and sense or value. It is a state of vital exhaustion”. Through the height of the pandemic, not only were health care workers working long hours to take care of patients, they were also affected on a very personal level.
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