Embracing Springtime Renewal: Dr. Lorna Breen's Legacy and Burnout in Healthcare Workers
How often do you hear something and think, “How didn’t I know this already?!” For me, it is not a rare occurrence. It can be about something historical, how to do something or fix something, a pop culture factoid, or even something in medicine. Today, this moment came from learning about Dr. Lorna Breen.
Dr. Breen was an emergency department physician in New York City, a job she’d wanted since she was a child. She had already published an article in The American Journal of Emergency Medicine examining physician burnout when the COVID-19 pandemic hit. According to the Dr. Lorna Breen Heroes’ Foundation website, Dr. Breen treated patients with COVID-19 as many did in the early days of the pandemic: with too little information, scarce PPE, and fear, suffering, and death all around her. She worked for days on end, hours after her shifts were supposed to be over, and truly exemplified the hero of healthcare who led thousands (millions?) of people to bang pots and pans outside their windows for support every night at 7 pm. She contracted COVID-19 and returned to work as soon as her fever resolved. After weeks of this torrent, “she became so overworked and despondent that she was unable to move” but was afraid to seek help lest she “lose her medical license, or be ostracized by her colleagues.” She had worked her entire life to be an emergency department physician. Overwrought, she committed suicide on April 9, 2020.
How didn’t I know this already? But maybe I did know it. Perhaps I heard Dr. Breen’s story on the news and felt what any of us would feel: disbelief, but then (honestly) complete belief, and then sadness, loss, and maybe a bit of uneasy recognition. Maybe her story got pushed out of my mind by the four-year’s worth of information I’ve learned since her death. Learning it now, though, the sadness and loss I feel is eclipsed by complete belief and recognition. According to Edward Ellison in “Beyond the Economics of Burnout,” 300 to 400 physicians commit suicide every year, a rate that is 40% higher than that of the general population for male physicians and 130% higher than that of the general population for women physicians. Those are not typos. Healthcare workers are still suffering. We are suffering while doing the work we were called to do. Relatedly, the work we were called to do is the cause of the suffering. How’s that for piling suffering on top of suffering? We get to beat ourselves up for doing what we’ve wanted to do since we were children.
As I write this, I’m in Ohio visiting my family, and glimpses of spring are poking through. The day is sunny and comfortable (until a bitingly cold gust of wind hits). Days like this can help us feel like we’re shaking off our autumn and winter habits: the head-down, do work, grind until the days are long again habits that we’ve had since we were schoolchildren. As spring starts, let’s look at our personal burnout levels. Have you been working some overtime shifts you’d rather not have? Have you been putting off taking a vacation because you’re telling yourself you’d just have a mountain of work to come back to? Have you been putting in a lot of “pajama hours” getting into the EMR to work on notes after your family is in bed? We don’t need to make it fancy. Don’t worry about standardized scales or that you may not be an emergency room physician in a major city during a pandemic. Just ask yourself, “Do I feel any burnout right now?” If you don’t, figure out why you don’t. Is it your boundaries? Is it your connections with colleagues? Is it your gratitude practice? Give yourself credit for what’s going well and re-commit to the habits protecting you from burning out. If you are feeling some burnout, now’s the time to start shaking off the autumn and winter habits that have you feeling that way.
Get curious about why you feel the way you do. As in the case of Dr. Breen, there can be many system-based reasons for you to be burned out. Our healthcare system needs a lot of work so those who work in it can flourish without working through periodic burnout. Systems take a long time to change, though, so we’ll spend years being burned out if we wait for the systems to change so we can feel better. Ask yourself, “How can I start fixing my burnout?” Don’t accept “I don’t know” as an answer. Our brains are designed to answer questions, but sometimes, they just don’t want to put effort into answering questions well. So if you ask yourself, “How can I start fixing my burnout?” and your brain answers, “I don’t know,” prod it a bit by asking, “But if I did know, what would the answer be?” That can nudge your brain out of hibernation and into some problem-solving. Then, start experimenting with the actions it comes up with. Letting your notes just be “done” instead of working towards a standard of perfection. Setting an alarm to prompt you to stop answering emails and leave the office in time for dinner with your family. Look for a hole in your calendar to sneak in a long weekend away. Little actions can sometimes lead to significant results on their own, but, more importantly, they can provide agency in situations where we feel we have none.
I’m coming to believe the words of Greek lyric poet Archilochus, that in times of stress, “we don't rise to the level of our expectations; we fall to the level of our training.” The autumn and winter grinds have put some helpful (and some unhelpful) habits in place. Let’s use the spring to bolster the training we fall to when we get burned out. Let’s look out for ourselves. And let’s look out for each other.
To learn more about the Dr. Lorna Breen, click here: Dr. Lorna Breen Heroes' Foundation
If you or somebody you know is suicidal, call or text the 988 Suicide and Crisis Lifeline at 988