About a month ago a photograph of an ED physician crying outside the hospital after losing a 19-year-old patient went viral online. Several of my colleagues from medical school and residency shared it on various social networks because it struck a nerve with so many of us.
During our medical education we practice giving patients bad news, we learn the right words to deliver tragic information when loss occurs or is imminent. Physicians are expected to be strong and stoic, somehow keeping personal emotion distanced — after all it is about the patient and the patient's family, not us. But really, it is about us too. Physicians have high rates of burnout, depression, addiction, and suicide because we often struggle alone, feeling unable to reach out for help. Even as we care deeply for our patients, we fail to do the same for ourselves.
Even as a relatively new physician, I have already shouldered the dreaded task of telling families their beloved daughter, grandfather, or mother has died. One case in my last year of residency stands out particularly strong. We were caring for a woman who was too young to be ravished by her poorly controlled diabetes; she was a double above-the-knee amputee with multiple medical comorbidities including hypertension and end stage renal disease.
We admitted her to the hospital several times during my time as a resident. Initially this admission did not seem much different; we would get her glucose under control, dialyze her, and tune her up until the next time. Shortly after rounding on her, a code blue came over the PA system. I ran to her room to find the code already in progress. We gave her chest compressions and jolted her body with electricity as we tried to get her back into a normal heart rhythm. After what seemed like forever, we called it.
My heart sank as I walked out of her room to see her grandmother and sister walking down the hallway. A nurse had called them from home to come quickly, but they were oblivious to what had transpired, and now it fell to me to tell them the bad news. I cannot forget the haunting plea in her grandmother's eyes as I tried to hold back the tears welling in my own eyes. I knew I should be stronger — I dammed up the tears.
I do not know if patients would appreciate or disdain our tears. I know that we rarely show our sadness at a patient's or family's loss; we dread admitting our inability to stop death in certain circumstances, and that is why this viral photograph stung so much. We walk away from our patients and our colleagues to cry alone, gripping the wall as the tears flow. Resources for help seem scarce — and as physicians, we fear vulnerability and often struggle alone.
With such a heavy burden, physician burnout continues to plague us. Moving ahead physicians should pull together and support a safe place to mourn the losses we face. Only then can we begin to chip away at the stigma that pushes physicians to self-destructive coping mechanisms. Depression, addiction, and physician suicide can only be addressed when we acknowledge the lack of strategies at all levels to support physicians who are in the darkness as they try to care for patients. The relationships we form with patients, we also need to seek with our colleagues. We need to support our fellow physicians as they reach out for help, just as we would our patients when they seek our assistance.