In Harm’s Way, the Tradition and Legacy of Medicine

 “There isn’t any such thing as an ordinary life.” – Lucy Maud Montgomery

“Heroes are ordinary people who make themselves extraordinary.”Gerard Way

Clouds, Sunset after winter storm, Falmouth, MA

Clouds, Sunset after winter storm, Falmouth, MA

My colleague, Dr. Jesse Ehrenfeld, is currently on leave from his academic anesthesia practice as well as from his post as Speaker of the House of Delegates for the Massachusetts Medical Society to serve as Lt. Commander Jesse Ehrenfeld, Combat Anesthesiologist in Kandahar, Afghanistan. We all appreciate the sacrifice he is making, putting himself at risk and in harm’s way.

This sacrifice is part of the great tradition of medicine, a tradition that compels physicians into war zones to take care of the injured. It is the same tradition that has us traveling to help treat diseases for which we may not have a cure or even a name yet, or into areas near and far ravaged by natural disasters.

As physicians we imagine that the risks we take are contained in far-flung locations or defined by the time it takes to start the recovery from disaster. Taking these risks is part of our  commitment and calling, our responsibility. These are not every day, ordinary events and circumstances. They are extraordinary, and we rise to those challenges, to be extraordinary ourselves to take care of them. Then life returns to normal.

But what about yesterday, an ordinary crisp sunny winter day in Boston? When at about 11 a.m. a man entered the cardiothoracic clinic at the revered Brigham and Women’s Hospital and  fatally shot surgeon Dr. Michael J. Davidson  before taking his own life. The patients, the doctors, the nurses and staff in the hospital and clinics were in the throes of an ordinary day, no grand events planned in the city, no special holiday.

In short, it was — or should have been — an unremarkable day.

We are shaken when we hear about events like these in hospitals. Hospitals are places of healing, a sanctuary. They are supposed to be off-limits to the violence around them; even in war, we deem it particularly heinous when a hospital is attacked or used to stage violent acts. But we may just be starting to realize that even here in our own cities and towns, doctors and nurses and hospital staff are always in harm’s way.

The list of dangers is actually quite long. Physicians are at risk for communicable illnesses, both common and rare; workplace violence by bullet, blade, and fist; abuse and assault, both physical and verbal. There are our occupational hazards, injuries, and stresses that lead to rates of burnout, depression, substance abuse and suicide that outpace our peers however measured (education, gender, generation). Every physician has been touched by these, either directly or as witness. I have a colleague who uses a wheelchair because of a bullet from a long-ago attack, and I have physician friends who have been shaken by death threats from patients or their families. I have seen a careers altered by hepatitis from needle sticks, nurses and doctors injured and even disabled by combative patients. We have borne the slaps, the punches, the verbal abuse.

I am witness, and I have also been victim to hazards that are always near.

Why are we afraid to study data that would establish and quantify the occupational hazards of being a doctor? Some of these hazards have been studied, but I have seen no comprehensive analysis of workplace risk for physicians like those that have been done for other professions. As physicians we have a sense of the risk, and yet we remain engaged, continuing to care for our patients. We participate in the disaster drills, we know where the safe rooms are in offices and clinics and we know “these things” happen. Perhaps society prefers to remain blissfully ignorant of the sacrifice and risk their doctors take on, comforted by the fantasy of the serene and nurturing hospital. Perhaps we are all loathe to let reality and data shatter the illusion.

And then shots are fired in a world-renowned hospital on an ordinary Boston morning and a gifted surgeon on the ascent of a promising career trajectory is wounded, and then dies, his colleagues unable to save him. There is plenty of trauma to go around. Even this place is no safe haven. We are forced to see this, all of us.

Today, we doctors as well as the nurses and hospital staff at this hospital and all of the others across the city, the state, and the country greet the new day and return to the work of taking care of patients. Caring for our patients, our communities, everyone.

Maybe it is time to be a little more aware and grateful, acknowledging that even outside of a war zone, we are in harm’s way.

To Dr. Michael J. Davidson, may his memory be eternal. Let us also remember and be mindful of all of the other doctors, nurses, and healthcare workers who are sickened, injured, disabled, and die as they care for their patients.

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