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A Prose on a Young Doctor's Suicide

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发表于 3-29-2021 15:07:04 | 显示全部楼层 |阅读模式
Richard E Leiter, MD, My Intern. New England Journal of Medicine, Mar 18, 2021, at page 986-987.
https://www.nejm.org/doi/full/10.1056/NEJMp2004154

Quote:

(a) " ' Bobby hasn't come in yet today," One of my chief residents told me. 'He isn't picking up his phone or answering his pager. Could you go and check on him?

"I was in my final year of my internal medicine residency and was on a 6-week rotation as the assistant chief residency. In this role, I organized educational sessions for the residents and medical students and helped with administrative tasks. Most important, I learned how to support other residents and responded to their needs, which is what much of my job as chief resident would entail the next year [that is, next year the author will become chief resident].  

"Bobby was an intern in our program, and he and I worked on a team together in early July. Bobby became my intern, and I was his senior resident. It was a role I cherished, and I tried to teach him all I could about caring for multiple sick patients simultaneously and navigating the systems, personalities, and politics of a large Manhattan hospital. We stayed late as we struggled to place an ultrasound-guided [because they could see a superficial vein with their naked eyes] IV into the arm of a patient whose veins were shot from years of dialysis. Perched side by side on a windowsill, we nearly missed morning rounds as we listened to a dying patient recount his journey fromIndia to the United States. By the end of our long, busy month together [suggesting the rotation of their team was a month long], I was proud the doctor Bobby had already become.

"Bobby lived in a building across the street from the hospital. New York prices being what they are, most teaching hospitals provide their residents with subsidized housing in the neighborhood. It's a strange, almost dormlike environment, with residents working and living together in close quarters.

"It was a cloudless yet cool August day when one of the other chief residents and I stepped out the side door of the hospitals. When Bobby didn't answer our knock, we explained the situation to the building's staff and they sent a maintenance worker back up with us. We soon discovered the incomprehensible reality: Bobby had jumped out his window. The usual din of Manhattan street below was eerily quiet. Cecil's Internal Medicine lay open on his tiny kitchen table, the pages gently flapping in the breeze from the open window.

"Somehow, we ended up in the emergency department and witnessed a compassionate but ultimately hopeless resuscitation attempt. While our program director broke the news to the other residents, we returned to our apartment and gave our statements to the police.

"The sudden death of a colleague would shake any workplace; in a medical training program where the boundary between the personal and the professional blurred into near nonexistence, its effect was seismic. When Bobby died, we asked the same questions of ourselves that others do when a close friend dies by suicide: What could we have done to prevent it? What had we missed? But we also had a different set of questions: Had something happened to our colleague the hospital the night before? We knew he had been on a particularly brutal rotation. Had he made a mistake? * * *

"A few days after Bobby died, my program director one of the chiefs, and I flew to his small Midwestern hometown to represent the residency program at his visitation. As I gave my condolences to Bobby's sister, she enveloped me in an unexpected hug/ 'Bobby told me you were the perfect resident; he wanted to be just like you.' Though she meant ot as high praise, her comment left me rattled. I couldn't escape thoughts that my expectations were too high or that I should have picked up on something wrong while I was working so closely with him.

"Residency leaves little time for self-reflection, though, and even less time for personal grief. The wards were as full as ever, and our patients and their families needed care. Because there was no one to replace us, we went back to work and processed the loss as well as we could. * * *

(b) "I threw myself deeper and deeper into my job, hoping that working to heal my patients's suffering would shield me from my own. * * *

(c) "Each year, approximately 300 physicians in the United States die by suicide,1 Medical students are particularly at risk, facing new professional responsibilities with the highest possible stakes, deep uncertainty about their own uncertainty about their own abilities,constant sleep deprivation, and isolation from family and friends. When I have a few seconds in residency to scroll through my social media feeds, I would see pictures of a world from which I felt completely removed. On Saturday nights. other people my age discovered new bands and ate at trendy new restaurants; ; I fought with the electronic medical record to input orders for laxatives and stood in line to perform chest compressions on a dying mother of two young children. These stressors form a dangerous and potentially toxic mix, particularly for trainees with preexisting or emerging mental illness.  

"Thankfully I received the psychiatric services I so desperately needed. I still have a scar, but it's well healed. I winder, though, how many residents in our program remained isolated in their suffering. * * *

My comment:
(a)
(i) The article is placed behind paywall.
(ii) My excerpt comprises three fourths of the prose.
(iii) Richard E Leiter is "Instructor in Medicine, Harvard Medical School." Dana-Farber Cancer Institute.
(iv) Richard E Leiter, MD, MA  Palliative Medicine
https://physiciandirectory.brigh ... chard-leiter-boston

"Contact[:] Dana-Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care [address and phone number omitted]

"Education[:]
Medical School[:] Northwestern University Feinberg School of Medicine

Residency[:] New York Presbyterian/Cornell Campus, 2013 - 2016

Board Certifications[:] Internal Medicine, 2015[;] Hospice and Palliative Medicine, 2018

Fellowship[:] Massachusetts General Hospital, 2016 - 2017"

(v) Natasha Velez and Shawn Cohen, Medical Intern Plunges to Death off Tower in NYC. New York Post, Aug 22, 2014 (online date)
https://nypost.com/2014/08/22/me ... ps-to-death-in-nyc/

(b) "veins were shot from years of dialysis"
(i) Obviously the shot is an adjective. It can not be a noun, meaning injection -- otherwise, shot must be plural (with an s) and still the meaning does not fit.
(ii) shot (adj):

"reduced to a ruined or useless state   <his nerves are shot>"
https://www.merriam-webster.com/dictionary/shot

"in hopelessly bad condition; ruined   <Those sneakers are really shot.>  <His morale is shot.>    BASED ON THE RANDOM HOUSE UNABRIDGED DICTIONARY, © RANDOM HOUSE, INC. 2021"
https://www.dictionary.com/browse/shot

(c) "we nearly missed morning pounds"

round (n): "(6)(a) a route or circuit habitually covered (as by a security guard or police officer) * * * especially : a series of regularly scheduled professional calls on hospital patients made by a doctor or nurse —usually used in plural”

Please read the entire definition (6).

(d)
(i) Cecil Textbook of Medicine
https://en.wikipedia.org/wiki/Cecil_Textbook_of_Medicine
(1927- )
(ii) The Welsh surname Cecil is "from the Old Welsh personal name Seisyllt, an altered form of the Latin name Sextilius, a derivative of Sextus meaning 'sixth.' The spelling has been modified as a result of folk etymological association with the Latin name C(a)ecilius, a derivative of caecus blind." Dictionary of American Family Names, by Oxford University Press.
(e) visitation (n): "WAKE entry 2 sense 3"
https://www.merriam-webster.com/dictionary/visitation
(f) Footnote 1 is: "Center C, Davis M, Detre T et al, Confronting depression and suicide in pysciauns: a consensus statement. JAMA 2003; 289: 3161-6."
(g) "Each year, approximately 300 physicians in the United States die by suicide"

Physician Census. Federation of State Medical Boards, undated
https://www.fsmb.org/physician-census/  
("985,026  licensed physicians in the United States")

Click the top red horizontal bar and you will reach in a new Web page:

Young A et al, FSMB Census of Licensed Physicians in the United States, 2018
https://www.fsmb.org/siteassets/ ... ions/2018census.pdf

Quote:

"Since 2010, the FSMB has conducted a biennial census of actively licensed physicians using data obtained directly from the nation’s state medical boards"  page 7.

"Methodology[:] The FSMB's member boards include all 70 state and territorial medical boards in the United States, the District of Columbia and several US territories (Guam, Northern Mariana Islands, Puerto Rico and the US Virgin Islands). For the purposes of this census, physician licensure data from 65 state boards overseeing the licensing of physicians in the United States and the District of Columbia are included. The US territories are not included because data from these jurisdictions are not always current or received in a timely manner to facilitate analysis. * * * licensure, specialty certification and disciplinary data on all licensed physicians with MD and DO degrees, as well as of physician assistants. The database represents the nation's only comprehensive source of current and accurate information about licensed physicians from US state and territorial jurisdictions that grant or renew licenses to practice medicine." page 9.
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