This story focuses heavily on suicide, and it might not be appropriate for everyone.
Dr. Pamela Wible is a family physician in Oregon. After learning that physicians have a higher rate of suicide than most professions, she set up a free suicide hotline for physicians. She's spent years counseling doctors and those who have lost a colleague to suicide. COVID-19 has put her in even greater demand.
In this conversation, she talks about the mental and emotional trauma doctors carry, and how they can be helped.
Dr. Pamela Wible: Well, I think now that we have the COVID pandemic, people can see behind the starched white coat, behind the fake smiles, that we are really suffering. Even on our best day as a physician, we're exposed to immense amounts of vicarious trauma. And, you know, because it's pretty hard to tell somebody in their 30s they have a terminal illness or, you know, to deliver a stillborn. You know, we're in scenes that most people never want to be in. And as a result, we are traumatized. Yet there's residents working 28-plus-hour shifts; there are doctors working 100-plus-hour workweeks.
And the crux of the matter is we are not allowed to get mental health care without fear of losing our license or having some sort of license repercussions. We actually can be punished for help-seeking. So I think the result of all of this is you've got intergenerational wounding from one physician to the next to the next generation of medical students because hurt people hurt people, you know, and that's just kind of … we're a bunch of really, really disillusioned, despairing people who want to do good in the world. But we're sort of all trapped in a system that's failing.
Kevin Kniestedt: So I can only imagine that, when you've been dealing with COVID-19 for about a year now, I can only imagine the extra layer or layers that have been added to physicians and med students as a result of that. Can you talk a little bit about what many are experiencing in this industry as a result of COVID-19?
PW: Well, many of the trainees are finding that they're in over their heads without proper supervision just because of the high volume of patients streaming through the doors. Right? And they're having to, you know, be involved in ICU situations and witnessing deaths, again, without receiving mental health care or even having time to take a break and eat a piece of bread or a sandwich or go to the bathroom. You know what I mean? It's really tough. And then, you know, in addition to this, medical students are in isolation from each other, having to study, you know, holed up in their apartments having not even met anyone else in their medical school class.
And we already know that one of the reasons why people will die by suicide is they feel completely untethered from their peers and feel completely isolated. There's these hospitals that are furloughing staff in large numbers, and then you have unemployed physicians again with thousands of dollars of student loan debt due every month. It's a nightmare.
And so how this has impacted me is that I had such an uptick in the number of people reaching out who are suicidal and struggling as health professionals during this time that I had to do group suicide calls, if you can believe that, instead of like a suicide helpline where I'm talking to one person at a time, which that one conversation can go on for two or three hours, then you can only imagine how many people can I speak to in a day at that rate. So I put them all on group Zoom calls confidentially, you know, like 10 at a time.
KK: So when you offer them this release valve, when they are able to express what they're feeling, what are they telling you?
PW: Oh, they're telling me and each other how much they love each other. They've never shared that before. I mean, if you can imagine the staff standing up and telling the doctors who are sitting amongst them that you're like a surrogate father, I love you. You're like an angel walking on this earth. I mean, the conversations that happened in that room were extremely profound. And I think the level of connection between individuals that you would see as just staff members in an ortho clinic, right, I mean, their connection is absolutely deeply emotional and spiritual beyond just sort of physically, “Hey, this is where I go to get my paycheck.” They love each other, and they've never had the opportunity to share these sorts of emotions with each other.
KK: What best practices can physicians, med students, what can they do personally?
PW: Well, I do think if we just express to each other how much we really do care for one another. It's amazing to me the number of physicians who've told me that a thank you letter has saved their life. I mean, they were on the verge of suicide, and they will review thank you letters that they saved from patients in their desk, or they'll get a text from, I mean … this is actually a true story an ear, nose and throat surgeon sent me recently, that he got a text from somebody.
I can pull it up and read it for you. “Hi, Pamela. Here is the text that prevented my suicide. 'Hey, I'm so sorry about your patient. That sucks. I'm very thankful that we have you as an excellent otolaryngologist to learn from you. You take care of so many sick patients and do a marvelous job educating us how to do it safely, skillfully and compassionately. Well, thank you for that.' It's been a particularly hard year for me, but I'm surviving. Thanks for all you do, Pamela.”
So that was sent to me by an ear, nose and throat surgeon who had apparently had a tough case, a bad outcome of some sort. And that attending's own resident sent a quick text, you know, just a quick text message saying, “Hey, you know, we really appreciate you as a teacher." That saved his life. He was on the verge of suicide.
KK: You've been tracking this and been involved with this for several years now, and I'm wondering if you've seen or noticed any progress made personally with doctors.
PW: I do find that some of these medical societies and also medical specialties are stepping up to protect each other, like orthopedic surgeons are talking about suicide among orthopedic surgeons in a way that I don't think they ever were, you know, before I got on this topic. And same thing with emergency physicians are now recognizing, “Hey, we're number three among all specialties in our suicide risk, and we need to address this.”
This is not going to be solved by whispering in the corners. If we did not say diabetes or high blood pressure out loud, we probably wouldn't be very far in helping our patients with hypertension and diabetes. Right? So this is … suicide is a medical condition. Using the dental health analogy, you know, mental health is a lot like dental health. With the dental health, we brush and floss and we go at intervals to see our dentist. And if we didn't do that, our teeth would be falling out of our mouths. So we have to ask ourselves, “What are we doing for our mental health? What is the equivalent of brushing and flossing every day for our mental health?” We need to do that to support our health-care heroes.
If you are having thoughts of suicide, or are worried about a loved one, the National Suicide Prevention Lifeline is 800-273-TALK. Or you can text the word "hello" to 741741.