It was less than 24 hours after Lorna Breen, MD, FACEP, died by suicide when The New York Times published the news. There it was, a headline the Breen family could have never imagined for their beloved sister, daughter, aunt: “Top ER Doctor Who Treated Virus Patients Dies by Suicide.”
Explore This IssueACEP Now: Vol 39 – No 09 – September 2020
Their world had been capsized by shock and grief, and the Breen family was huddled together in Charlottesville, Virginia, holding this horrific, unthinkable news as their own tragic truth. The Breens did not want to tell anyone about Lorna’s death, and they certainly did not want to announce it to the Times’ 47 million Twitter followers. But the news was out there, and there was nothing they could do about it.
As the family cried together, they tried to figure out what to do next. “Jennifer and I had this incredible moment of clarity,” said Corey Feist, Lorna’s brother-in-law. “We needed to lean into this conversation, and we needed to shine a light on it.”
The Breen Bond
Jennifer and Lorna Breen were “soul mates,” according to Corey. Jennifer was younger than Lorna by 22 months, and they were inseparable. The sisters developed their own language as children and kept it going into adulthood, often switching into it for secret sister chats. To Corey, a health care executive, Lorna was a “big sister” who shared his passion for running and was his favorite person to talk to about the quirks of working in the medical industry. To the Feist children and her other nieces and nephews, Lorna was “the cool aunt,” a status she greatly treasured.
The Feist family had just wrapped up their annual vacation with Lorna when she returned to unfamiliar territory at the emergency department at NewYork-Presbyterian Allen Hospital. COVID-19 had dramatically changed the landscape while she was traveling, and she immediately started sprinting to keep up with the increasing patient loads and rapidly changing protocols. It was March 18—only four days after returning to work—when she experienced her first COVID-19 symptoms.
The Feists spoke with Lorna daily as she tried to manage the illness alone at her home. Feverish and weak, she expressed concern for her colleagues and their safety, worrying about the personal protective equipment shortages and many staffers who had also fallen ill. She tried to help with a group project for the MBA program that she was enrolled in and kept in touch with her Bible study friends. Gifted with an incredible motor and work ethic, resting didn’t come naturally for her. The woman who regularly ran marathons was now winded by doing the dishes. Still, she knew she was urgently needed back at work.
She returned to work in the emergency department on April 1. The stress and workload had only mounted while she was sick, but she could no longer pull from her legendary energy reserves. Lorna was scheduled to work nine 12-hour shifts in a row, and she stayed late every day. A relentless stream of flashing ambulances delivered COVID-19 patients to the hospital. Sleep eluded her. Jennifer and Corey were very worried about Lorna—they could hear the deepening distress in her voice.
The Stigma Trap
Months after Lorna’s suicide, Corey reflected on the cascading events that led to the Breens deciding to shine a light on one of the darkest topics during their family’s darkest hours. He explained that they initially fell into the same trap as most families who lose a loved one to suicide—they wanted to stay silent to avoid the stigma associated with it.
They may have remained silent, but the Times article put them on the spot. The Breens were caught in a stigma standoff. On the one hand, suicide stigma implores you to stay quiet about your tragedy. Keeping your secret means you don’t have to answer unwanted questions and relive your tragedy over and over again. The unbearable grief and pain? Stigma says keep it to yourself.
On the other hand, what about the stigma Lorna faced as a health care hero on the front lines of COVID-19? She witnessed unimaginable suffering as the COVID-19 losses piled up, but she was trained to never show weakness. And what about the stigma that persists in medicine that says it isn’t OK to sit down and take a break? The stigma that prevents health care workers from seeking crisis support because they’re worried it will affect their licensure and career prospects?
In the blink of an eye, they had to make a decision about how to move forward and honor Lorna’s legacy. Once the family decided to share their story, they set a movement in motion.
The first thing the Breen family did was set up the Lorna Breen Heroes’ Fund to provide mental health support to health care professionals. Soon that grew into a foundation dedicated to protecting and preserving the wellbeing of health care workers while destigmatizing mental health support for clinicians. The Lorna Breen Heroes’ Foundation has told her story to many audiences over the last three months, furthering its mission to prioritize the protection and well-being of health care workers while breaking down barriers that prevent clinicians from seeking mental health support.
In June, Jennifer and Corey submitted written testimony to a Congressional hearing examining the pandemic’s toll on the mental well being of clinicians. The Feists included multiple calls to action imploring the various entities involved in the clinician wellness crisis—the health care industry, federal and state governments, health care rating agencies, and the clinicians themselves—to each do their part to chip away at the harmful stigmas that keep clinicians from seeking support.
In late July, Sen. Tim Kaine (D-VA), Sen. Todd Young (R-IA), Sen. Jack Reed (D-RI), and Sen. Bill Cassidy, MD (R-LA), introduced S. 4349: The Dr. Lorna Breen Health Care Provider Protection Act to honor Dr. Breen and prevent suicide and mental health issues among health care professionals amid the COVID-19 pandemic and beyond. The movement was gaining momentum.
For the Breens, the cause is equal parts uplifting and heart-wrenching. The hardest part, Corey said, has been reliving their loss over and over again. “When we’ve wanted to advance the conversation to how we can help others, what we keep getting pulled back to is, ‘Tell me the story again—we want to hear the gory details.’” As the Breen family grieves, each media interview and article published resurfaces painful feelings that leave them emotionally drained.
Lorna was a natural problem solver, a woman of action. At the time of her passing, she had recently co-authored a paper on physician burnout and was almost done chairing the work group that created ACEP’s point-of-care tool for managing patients with autism in the emergency department. (Her nephew has autism, Corey explained, so she was particularly passionate about that project.)
Powered by the same problem-solving instincts that fed Lorna’s drive, the Breens are dedicated to shifting the focus off Lorna’s personal story and on to the solutions needed to protect and prioritize the emotional well being of health care workers. “That’s the way [Lorna] would have operated,” Corey explained.
As the public and medical community mark Suicide Prevention Week (Sept. 6–12) and National Physician Suicide Awareness Day (Sept. 17) during this pandemic that has only compounded the nation’s mental health crisis, the Breen family said they will continue to speak to the unspeakable in Lorna’s honor.
“She cared so deeply about her colleagues. …We feel like this work is spreading her,” Corey explained. “It’s the hardest thing I’ve ever done in my life. And it’s the most rewarding.”