Put Your Own Oxygen Mask On First
Authors: David Atkins
Journal: Annals of Internal Medicine (2020)

On Being a DoctorFebruary 2021Put Your Own Oxygen Mask On FirstFREEDavid Atkins, MD, MPHDavid Atkins, MD, MPHVeterans Health Administration, Washington, DC (D.A.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-6349 Audio Reading - “Put Your Own Oxygen Mask On First” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads “Put Your Own Oxygen Mask On First” by David Atkins, MD, MPH Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail They streamed into Memorial Church in twos and threes on a piercingly beautiful Cambridge fall day: clinic and hospital colleagues, patients from his primary care practice, and siblings and cousins from a sprawling New England family. They passed by the two collages showing an exuberant 70-year-old man at various stages of his life—dressed as Malvolio in a high school production, camping across the country as a long-haired activist, playing the piano with his children and grandchildren—and thought to themselves, “How could a doctor who meant so much to so many take his own life?” As I greeted cousins and family friends who came to honor my oldest brother, I asked myself, “When does devotion to a job you love become hazardous to your health?”Skip had been a primary care clinician for over 40 years in the Boston area. He served a diverse, working-class immigrant population, first in Cambridge and then in Chelsea. He loved being a community doctor in every sense. To better care for his patients, he added Spanish to his schoolboy French, then Portuguese, then some Croatian. He made frequent house calls, helped integrate social services and mental health at his clinic, established a legal aid office for clinic patients, and chaired the local Board of Public Health. It seemed like half of the police force were his patients, and it was a rare trip to the local supermarket when one of his patients didn't ask for a curbside consult. His adopted community became his family, and they loved him back.All families of suicide victims struggle to find sense in a seemingly senseless death. Like Tolstoy's families in Anna Karenina, each suicide is unhappy in its own way. My brother's life nearing the end of his career seemed full with family, friends, travel, and music. One month earlier, he had walked his youngest daughter down the aisle at a wedding packed with hundreds of friends and family members. On the other hand, depression ran in our family, and he had struggled with it on and off over the 10 years since losing his oldest daughter at age 22 to a glioblastoma. The prospect of retirement cast a pall. In notes from his 40-year college reunion, he asked, “Anyone have secrets to successful retirement? As I approach it, I admit I am stumped.”Most recently, he had confronted the reality that a small intracerebral bleed he had 2 years earlier had left him with cognitive deficits that affected him more than we noticed. In a note discovered after his death, he stated, “I know I can no longer practice. This would set me adrift, with no end.” A future without his practice would be like a life without his family. Most of all, the prospect that he would eventually shift from being the carer to being cared for was terrifying. “I can't stand the idea of not being able to be helpful.”The week before he died, while on an annual canoe trip in northern Minnesota, I browsed the cover story in The Atlantic by Arthur C. Brooks on managing your declining career. Brooks observed that accomplished people struggle with retirement because they resist the idea that they need to adapt to how their skills change with age. Moreover, successful people often have trouble building an equally fulfilling identity outside of work. Nobody needs them in the same way that they were needed at work. Although my brother had many friends and interests outside of medicine, his eulogies were full of stories of going the extra mile at work: telephone calls to patients long after he had promised to be home, extra weekend rounding to make sure his patients on the university service were well cared for, and house calls to a friend's ailing father.As with many good physicians, this habit was as natural to Skip as calling in a prescription. His patients adored him for this, and I doubt he ever viewed it as a burden. However, as I listened, I couldn't help but think of the other side of the ledger: of time taken away from being with his wife, playing the piano, or preparing for life after medicine. With more attention to his life outside of work, could he have made peace with all that he still had to contribute to those around him?When I spoke at the memorial service, I noted that—although I longed to emulate my oldest brother—I found his brand of selflessness too hard. “It meant doing things even when they were inconvenient and caring about people whether or not they were fully deserving or sufficiently grateful. Truly being selfless turned out to be a lot of work, and I was happy to leave it to Skip and the Sisters of Mercy.”I also mentioned my hope that his colleagues would honor his memory by spending time taking care of themselves. “Selflessness has its price. Skip was so ready to give someone the shirt off his back that he may not have realized when he was also cold. I hope each of you—especially those of you who are doctors and nurses and caregivers—will take time to be selfish when you need to be. Make a lunch date with your Skip to complain about your problems. Put your own oxygen mask on first.”In the era of COVID-19, when it is commonplace to honor nurses, doctors, and other health care personnel as heroes, I worry about the subtle toll of living up to that image. Heroes are selfless and tireless. No hero looks at their watch and says, “Okay, time to head home to family.” However, when our heroes are human, they need to rest; be able to ask for help; and be allowed to say, “I'm done. I need a break. My turn to be taken care of.” In honor of National Suicide Prevention Month, to all my health care colleagues, please, put your own oxygen mask on first. Comments0 CommentsSign In to Submit A Comment David M. Sack, MDConnecticut GI, PC18 September 2020 Caregivers Your eulogy for your brother was as moving as your plea was convincing for us practitioners to rember our personal needs more. But there is so much more than selflessness involved, and some of those factors may not be so easily changed. Some of us labor out an exaggerated sense of duty, some to consciously or unconsiously make up for injuries they have been done to themselves or others. Some of us are simply incapable of failing to right what is wrong, and there is always something in need of fixing. For some it is perfectionism. Finally, for better or for worse, in all of us there is a kernal of pride in our achievement and altruism that we are unwilling to risk by being less than perfect as doctors. Oxygen masks help, but sometimes it is better not to board the saintly doctor plane to begin with. Tina Dobsevage, MDMount Sinai and Lenox Hill Hospitals, Director Tina A Dobsevage, MD, PC6 May 2021 An Appreciation This past year has put enormous stress on those of us who are primary care physicians to the elderly. I tend to fall into the selfless role. This article reminds me to set aside time for my family and friends. Author, Article, and Disclosure InformationAffiliations: Veterans Health Administration, Washington, DC (D.A.)Corresponding Author: David Atkins, MD, MPH, Veterans Health Administration, Office of Research and Development (10X2), 810 Vermont Avenue NW, Washington, DC 20420; e-mail, David.[email protected]gov.This article was published at Annals.org on 17 September 2020. PreviousarticleNextarticle Advertisement Audio Reading - “Put Your Own Oxygen Mask On First” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads “Put Your Own Oxygen Mask On First” by David Atkins, MD, MPH Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics February 2021Volume 174, Issue 2Page: 271KeywordsHabitsHealth careHospitalsMemoryOxygenPatientsPrevention, policy, and public healthPsychiatry and mental healthSuicideVeteran care ePublished: 17 September 2020 Issue Published: February 2021 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...