Dr. Becher has been moving quickly for most of her life. She started medical school at the age of 21 and has trained for two marathon. In the halls of her clinic, between a bank and a Baptist church, she walks fast, looking down at her phone as she speeds around corners. She organizes her staff and speaks with a mountain accent.
When she enters an exam room, her aspect changes. The intense beam of her attention softened as she perceptibly percepted.
A mother and son came in for a checkup with Dr. Becher, who was dressed in bright pink scrubs. He wore a newsboy cap and a blue surgical mask, and he has a rare disease that is similar to multiplesclerosis. After five years of treatment with mixed results, Zane did not attend school in person. His mother told the doctor that he was almost back to being a normal boy.
The family had been bouncing from doctor to doctor for years when Dr. Becher made the datememe datememe datememe datememe. She can figure out things that no one else can. The risk of Covid-19 was the topic of debate in July.
What do you think about schools? Dr. Becher was asked by Ms.
The doctor's head was turned. She said that you may have to consider the social benefits in addition to the health risks. I don't want you to feel like you can't have a good life because of Covid. Live your life. The two people nodded.
Do you mean to over over Clay? Dr. Becher wanted to know if he could attend Herbert Hoover High School and Clay County High School. The teacher at Hoover laughed. She asked if he would like to discuss that.
He said that it wasn't really.
He said it was the first thing he had said, and they all laughed.
Community Care of West Virginia is a federally qualified health center where Dr. Becher has worked for eight years. The state of West Virginia has the highest prevalence of overweight people, the fourth highest poverty rate, and the shortest life expectancy. There is no stoplight or hospital in Clay County. People living in a food desert. Dr. Becher is the only family doctor in the county. She visits children in their living rooms to immunize them, organizes food drives and administers buprenorphine to treat opiate addiction.
As the political climate around Covid-19 got more heated, she became frustrated and angry. She began to run for hours at a time. She was angry about the widespread distrust of vaccines, the teachers who went to school even after testing positive for the virus, and the lack of affordable transportation, among other things.
A suffocating stack was formed by the indignities layers on top of each other. Dr. Becher was angry at how she couldn't do anything about it. She chugged a beer and ran after work. On April 17, her heart stopped.
Two psychologists at the University of California, Berkeley published a paper in 1981 on the topic of "the burnout syndrome." The authors set out to measure the degree of stress and emotional exhaustion experienced by professionals like doctors, social workers, therapists and teachers.
The M.B.I. has become a scientific standard. A high score on the M.B.I. has been linked to increased errors and decreased patient satisfaction. Higher rates of cardiovascular disease, substance abuse and divorce can be found in burned-out doctors. In a study of 5,000 physicians, 44 percent showed at least one sign of burnout. 54 percent of doctors and nurses were burned out, according to a report by the National Academy of Medicine.
Patients almost become a part of your family when they embrace you as a part of their community. A lot of physicians go into family medicine because of these relationships. In isolated rural areas with chronic illnesses and social disadvantages, the sense of dependency can put a significant emotional burden on doctors.
Dr Becher was at a chess tournament with her son when she suddenly felt unwell. Her blood pressure was dangerously high and she left for the emergency room.
She was found to have takotsubo cardiomyopathy, a rare disease that causes the left ventricle to stretch. Older women who have recently experienced some type of intense physical or emotional distress, like the loss of a loved one, are more likely to have a case. The cause of broken heart syndrome is not known.
Dr. Becher was in the hospital arguing with the doctors. Mike Becher had to take away his phone when his wife was being diagnosed. She protested until she saw that a portion of her heart had been damaged.
The very thing that brought me to this cold, hard table was anger. I felt completely embarrassed. I didn't have the strength to follow the path I set myself on.
She said that no one put her in this situation. I applied to medical school and got a job in rural primary care. Acute stress is the most common cause of Takotsubo's. It was obvious to me that mine was from going to work everyday.
Sissonville is an hour west of Clay. She wanted to leave West Virginia and not come back. She met her husband while taking one of her first courses at Denison University. He studied environmental law in Cincinnati and she worked at an Olive Garden.
She returned to West Virginia to study medicine at Marshall University. She said that she liked living in places with everything she wanted. After finishing her residency, she and her husband and son moved into a house atop a hill in Clendenin, which is close to the clinic in Clay. She had a large amount of student loan debt.
Dr. Becher looked out at the trees and pond at the bottom of her hill and said that Mike had two requirements. He had to be able to shoot from the porch because we couldn't see anyone else. She enjoyed it. She said that she needed to feel lonely and tortured.
In Clay, Dr. Becher built up patient equity. She slowed down when talking to her patients and learning about their lives and health issues, which could stem from causes as varied as diabetes, opiate addiction, anxiety, loss of electricity or an old car that had recently broken down. Outside of these relationships, she kept going. She took on advisory roles in local government, increased the number of patients she saw, and made more home visits to people who couldn't drive.
Mr. Becher said thatKimberly would rant about insurance companies. She has been the same since we met.
The only grocery store in the county was destroyed by a flood in the summer of 2016 Dr. Becher came up with a list of inexpensive, minimally processed foods that she could recommend to her patients. She was lobbying for a new grocery store and helping to organize monthly food distributions by 2020 when the Pandemic was in full swing.
I was living in eastern Kentucky and reporting on how the Pandemic was affecting food access in Appalachian communities when I drove out to talk to her. A group of nurses were administering Covid tests through rolled-down windows at the parking lot where we met. Over the next several days, nearly 200 families would benefit from a food handout that Dr. Becher had helped organize.
She said that if they kept giving out enough food for two weeks every month, they wouldn't be able to get a store. There isn't a store I will be giving out food until there is a store.
Hunger and a poor diet were the primary health issues that her patients faced. She said that most of them had enough money to buy healthy food, but many drank a lot of soda. Others had to choose between paying for internet service or fresh produce because they couldn't afford to fix their car. Blood-sugar levels and blood-pressure readings kept rising even though Dr. Becher started paying some people's bills.
She said that you don't have a way to make a difference. You can't get food. That really doesn't make sense.
I drove to Clay again early in February of 2020. I met Dr. Becher in the doorway of her clinic as she talked to one of her nurses. West Virginia had one of the highest vaccination rates in the country and Dr. Becher was helping lead the region. She was going to bring vaccines to patients at home. She had two nurses, 10 vaccine doses, and a four-wheel drive.
Dr Becher told Ms. Dean that he was excited for her. I would like to do it.
Ms. Dean said that she had a full schedule.
Dr. Becher would stay up late at her kitchen counter, writing notes on patients' charts and applying for food vouchers while she worked in the clinic. Patients were questioning her judgment after she encountered resistance to Covid science.
People describe similar experiences. A patient who had been with Dr. Becher for a long time came in with Covid. The patient said they were not going to talk about the test when the doctor recommended it. He took me out of the office and fired me.
Several studies have shown that the H1N1 changed the way physicians and health care workers view their work. In one study, more than 20% of respondents said they had been bullied, threatened or harassed by their patients. Many people who had no margins left were pushed over the edge by Covid.
Ms. Dean went to the mountaintop home of Bonnie White to give her a second dose of the vaccine. I don't know if I need the second dose. "Ms. White, what do you think?" Ms. Dean said that Dr. Becher thought you should get it. You can trust her to get it if she wants you to.
Ms. White did what she was told to do. She's the best doctor I've had.
Most of Dr. Becher's patients got the vaccine after she told them to. Older patients began coming to her depressed, unable to see their children or grandchildren as a result of the swine flu. In Wyoming County, W.Va., Dr. Becher and Dr. Bailey talked about vaccine distribution, their mounting paperwork and the need to make long-term plans for their communities.
I asked Dr. Bailey if he was angry with the patient over the vaccine. I can no longer argue about this. I'm going to tell them it's recommended, and then I'm going to say something. I don't think it's large for me.
Dr. Becher couldn't let it go She tried to channel her frustration by joining more boards. Her husband knew that the pace she was keeping was not sustainable, but when they talked about it late at night, they realized there was no stopping.
She stopped seeing patients when her heart stopped. She quit all the boards she was on. She was on bed rest and trying to figure out what had gone wrong. She questioned why she agreed to do so many home visits. I don't live in this town, so why did I work so hard to make it easy to get food? I don't understand why I kept saying yes to everything.
She knew it had almost killed her, how could she come back?
Dr Becher realized the roots of the challenge. A lot of new physicians carry a lot of student loans when they start practicing.
According to Dr. Becher, most health care organizations don't value your well-being as much as they should. She has student debt that is still above $60,000. She said it wasn't just a financial thing. When you are in a more rural area, you might be the only source of care.
Dr. Becher reduced her time in the clinic to one day a week after moving to a more administrative position. She wrote in February that she had to tell her story in order to help other physicians learn from her mistakes. I am a work in progress, and I am always on the edge of a cliff, at risk of jumping back into being angry and hurting myself again. Now I know there is a cliff.
After reading the post, Dr. Lisa Lavadie-Gomez, a family doctor in Iowa City, reached out to her patient. Two physicians talked about their experiences.
Dr. Lavadie-Gomez said that the empathy and altruism wore him out to the point where he was no longer needed. I'm taking care of people but I'm broken. How do you keep moving?
Since last April, there have been moments where my life is so different from before. I had a few runs of heart rhythms that were not good and I have a fear of dying.
Dr. Lavadie-Gomez said that she was leaving medicine. She said that she will be a doctor for the rest of her life. I will have the same skills and abilities. I have decided to use that energy somewhere else. I haven't admitted that I'm leaving my job yet, but I'm talking to her.
A third-year medical resident from Eastern Tennessee State University was invited by Dr. Becher to work her day in the clinic. The region had been without a family doctor for more than a year.
As the two physicians squeezed into the nurses office, Dr. Jarrell said, "This is why you do medicine." Dr. Jarrell asked Dr. Becher with logistical questions. Are you referring to the nearest hospital? It was about 45 minutes from the clinic to where you were going. Dr. Becher has a threshold for opiate prescriptions. It's very high. The number of patients? All over the place. The morning-after contraceptive pill was prescribed by her. The doctor said yes. The doctor pumped her fist with support.
Dr. Becher had been seeing Dany for a couple of years and she was now weighing the options for surgery
She's on hormone therapy. "Do you know what I'm talking about?" Dr. Jarrell asked.
The doctor said yes.
The doctor said it was awesome. You do that here?
Dr. Becher said that he did that at his practice. If you came here and did it, I'd love it.
Ms. Frye thought about the appointment. She didn't know how it would change her life. It's so shocking to have that resource in a small county. We just have her here.
Although her most recent echocardiogram was normal, she hadn't run in over a year. Her marathon dreams were over when she was working up to a turkey trot with her husband and son. She said that she can't do long running again. That's what I did. That was something I did for a living. I did nothing else.
A support group for rural physicians has been created by Dr. Becher at Community Care. The director of the center, who has known Dr. Becher since she was in medical school, said that she kept all this close to her vest. She is creating a new path for herself that isn't all about patient care.
The two doctors squeezed into a room with Larry O'Dell, a patient who had just lost his wife. Although he had lost most of his hearing, Mr. O'Dell was still able to work in his garden most of the time. He had his daughter with him for the visit and she frequently spoke into his ear about what the doctors had said.
After Dr. Becher ran a physical exam, he sat and chatted with Mr. O'Dell about his garden.
He said that he knew what he was talking about. The last time I saw you, you looked worse.
Dr. Becher was taken aback by the gesture.
He wanted to know if he was better.
She stated that she was better. I'm a better person. She paused and said she was wondering why you were staring at her. Everyone in the room had a good laugh.
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