Legislation takes proactive measures to promote wellness, mental health resiliency and suicide prevention for COVID-19 pandemic response healthcare professionals.
The rates of depression, divorce, professional burnout and suicide for emergency physicians have exceeded the national average for decades.
I recall being informed of this fact when I was an emergency medicine intern, and the gravity of this glaring problem was kept locked in Pandora’s Box like a shameful secret. The COVID-19 pandemic, a truly historic public health emergency, has revealed opportunities for improvement in patient care and emergency response and magnified the longstanding disparities in economic status, race and access to healthcare.
In “normal” times, emergency physicians work long hours in a stressful environment. We witness horrific things that others will never be prepared to see. In the midst of a pandemic, emergency physicians constantly enter a battlefield, often without the appropriate resources or staffing, with no defined end in sight.
At the onset of the COVID-19 pandemic, I experienced the healthcare system from the patient’s side of the fence as I was recovering from surgery while simultaneously being fully engaged with the pandemic response activities for the State of Ohio from my hospital bed.
During that time, I wrote “The Human Side of Us,” an article that was published in JEMS (Journal of Emergency Medical Services) on Easter Sunday, April 12, 2020. I highlighted the challenges and inherent struggle of healthcare workers trained in a civilian setting who were now unexpectedly immersed in an austere military combat zone with unprecedented daily rates of morbidity and mortality.
I wrote “Lastly, and one of my greatest concerns, is not the economic aftermath of this pandemic, but its psychological impact” and “Without aggressive intervention, our healthcare force will erode beyond the resolution of this pandemic due to voluntary departure from or change in their profession, inability to return due to post-traumatic stress or depression, or, in the worst scenario, suicide.”
My heart shattered as I watched a national news broadcast and learned of Dr. Lorna Breen’s suicide on April 26, 2020. The broadcast mentioned the detrimental effect that the COVID-19 pandemic had upon both her physical and mental health. My worst prediction regarding the adverse impact of the pandemic upon practitioner wellness had come to fruition.
Dr. Breen served as an Assistant Professor of Emergency Medicine at Columbia University Irving Medical Center and was a deeply loved daughter, sister, educator, administrator, mentor, community partner and dedicated patient advocate and caregiver. In every photograph that I have seen, she is smiling and clearly infusing those around her with happiness.
When I returned to my clinical duties in June 2020 following my medical leave, I directly witnessed the stress and fatigue of all first responders and healthcare workers. My colleagues from all over the nation shared their nightmarish experiences with me. A significant number of our EMS clinicians and healthcare providers had fallen ill due to COVID-19 placing a strain on our workforce, and the number of available inpatient and ICU beds diminished statewide.
In October 2020, two colleagues confidentially reached out to me, one of whom was suicidal, requesting assistance in identifying the medical services that they needed to better deal with the stress.
As healthcare workers, access to the appropriate psychiatric care is a challenge due to multiple factors including, but not limited to, the desire for privacy, the fear of appearing “weak” in the eyes of co-workers, and a lack of true understanding of the caveats of the practice and needs of emergency physicians by psychiatrists and counselors.
I drove my suicidal friend two hours away across state lines before we reached a facility where he was confident and comfortable that he would be anonymous.
While on duty in the emergency department two days later, I received the horrific news that one of my residency classmates had tragically committed suicide after previously expressing stress arising from the COVID-19 pandemic.
At the time, Dr. Richard Hunt, the senior medical advisor at the U.S. Department of Health and Human Services Office of ASPR, and Dr. Jon Krohmer, the director of NHTSA’s Office EMS, were hosting weekly National COVID-19 Clinical Rounds webinars in partnership with Project ECHO. Upon learning of this tragedy, they asked me to make a presentation on physician suicide.
Although I wasn’t sure if I was emotionally ready to do so, I felt that I did not have a margin of time to waste because every day that passed without bringing this painful topic to the forefront could result in additional deaths from suicide that may have been preventable.
During my Nov. 5, 2020 presentation, I highlighted the three barriers that are more difficult for emergency physicians to overcome compared to other populations: the stigma of mental illness, access to healthcare and stoicism.
On March 24, I was immensely honored and deeply humbled when I was informed by Columbia University that I had been selected as the keynote speaker for the inaugural annual Lorna Breen Memorial celebrating women in leadership on April 21. The goal of Drs. Penelope Lema and Tiffany Murano, fellow faculty members of Dr. Breen, was to create a program to celebrate Lorna’s life and her positive contributions to the world.
I had the incredible opportunity to converse with Dr. Breen’s family and friends at a depth that the woman that I had never met was far from being a stranger— especially when I discovered our common thread of the love of music. At the time of her passing, it was impossible for the media outlets to fully capture and communicate the joy that salsa dancing and playing cello in the Late Starters Orchestra brought to Lorna and the thousands of physicians that she inspired over the years.
Despite the overflowing ICUs and refrigerated trucks transformed into overflow morgues, the media also could not convey the burden of stigma-laden fear generated by the requirement to attest to seeking mental health treatment for acquisition or renewal of a physician’s licensure to practice in many states.
With the support of Dr. Breen’s family, Senator Tim Kaine (D-Virginia) and Rep. Susan Wild (D-Pennsylvania) outlined a proposed bill during the memorial event that, if passed, would remove the cloak of shame and secrecy and directly address the need for a mental health and wellness safety net for healthcare providers.
On Aug. 6, I was ecstatic to learn that that U.S. Senate approved the Dr. Lorna Breen Health Care Provider Protection Act, Senate Bill 610. If approved by the U.S. House of Representatives and signed into law, our Pandora’s Box that has remained sealed for far too long can be opened to allow its dark contents to be replaced with proactive and effective solutions. The parameters in the Dr. Lorna Breen Health Care Provider Protection Act are essential to our profession.
The U.S. Department of Health and Human Services (DHHS) will be tasked to identify and disseminate evidence-based best practices to promote wellness, mental health resiliency and suicide prevention specifically for healthcare professionals and those involved in the COVID-19 pandemic response. DHHS will also be tasked to develop policy recommendations to address psychiatric injury prevention, access to mental health care resources and enhancement of resiliency.
As a staunch advocate of mentorship, I am most excited about the development of resiliency training that should be incorporated into the curricula of medical schools and residency programs to better ensure a foundation of strength for our entry-level healthcare providers. A culture change is direly needed to eliminate masking toxic stress and depression with stoicism.
Most importantly, the approval of Senate Bill 610 is yet another beam of Lorna’s shining light. Clearly, she is still with us showering the world with love and light through everyone that she has mentored and will continue to support, forever.
We all experience hills and valleys in life; however, a legacy is created by one’s generous contributions to humanity during a lifetime and not defined or overshadowed by one cloudy day.
If you can do one thing for Lorna and her mission to make the world a better place, please contact your respective U.S. representative, share your valleys as an emergency physician before and during the pandemic, and urge them to support the Dr. Lorna Breen Health Care Provider Protection Act. The preservation of our lives and those of future emergency physicians depends on it.
As I stated during the first annual Lorna Breen Memorial, I cannot, nor will I ever, speak of Lorna in the past tense. Lorna is still working diligently to embrace and support the vulnerable, mitigate the suffering of others and teaching others how to traverse life’s journey dancing to salsa and smiling brightly even in the rain. Lorna is.
Learn More about Lorna
If you would like to learn more about Dr. Breen and the efforts to combat physician burnout and fortify their well-being and job satisfaction, visit the Dr. Lorna Breen Heroes Foundation (www.drlornabreen.org).
The annual Lorna M Breen, MD Annual Lecture series seeks to honor her memory by inviting similarly passionate leaders. This annual lecture honors Dr. Breen’s legacy by continuing to promote many of her passions including leadership and professional development. To donate, visit https://medicine.givenow.columbia.edu/?alloc=26528#