The reason our policies have failed is because we have not confronted a simple truth: We must care more about saving and improving the lives of people who use drugs than stopping drug use.
Residents who have experienced different waves of this crisis expressed frustration, fear, and hope about what they experienced, and what the future will bring.
I asked Dr. Lake what she wanted other doctors to know outside of Washington.
“This is going to get worse,” she told me after a long pause. “And we all have to hold each other up."
Telling a thousand strangers about my lowest point in medicine was harder, and more rewarding, than I anticipated. It also taught me about medicine’s destructive culture of shame.
Residency’s long hours, trauma, sleeplessness and social isolation inevitably erode our healthy coping mechanisms. At the same time, there is a powerful culture of fear, stigma and lack of self-care that prevents residents from seeking help. The resources that are in place in residency programs are simply not adequate.
Medicine has long been a career path in the US for women in science, with women entering the field in nearly equal numbers to men for 20 years. But along the way, many women fail to advance and to earn the same recognition and salaries as their male counterparts. These differences are often framed as “individual failures”, in spite of the robust evidence of gender discrimination. Women are told to advocate for themselves, to be better negotiators, and, in private, not have children if they are going to succeed.
I started writing this article a few months ago with a simple question: why were there so few women in top positions of academic medicine when we have had near gender parity in medical school for decades? As I was asking this question, many of my female friends talked about being passed over for promotions, cutting back their hours because they needed more flexibility for their families, navigating gendered criticisms from trainees and peers, and facing pathetic maternity leave policies that are in direct contradiction to what we know about the medical facts of childbirth.
When patients are at the end of their life, it is an opportunity to step back from the day-to-day accounting, to take stock of their lives, to try to let them know that they are loved, and attend to their most pressing needs. In disasters, too, we have a chance to step back, to think about what happened and how we can do better next time, to consider what would make an effective meaningful response to future tragedies.
