“My first thought, as I viewed the CT images, was a somewhat fantastic notion that the tumor on the monitor screen could not possibly be real,” recalled Jennifer Lycette, M.D., an oncologist with the OHSU Knight Cancer Institute practicing in Astoria.
“Then I wondered how it had come to be. Somehow a living, breathing woman had been bearing this tumor — for many months, if not years, judging by the size of it. All without medical care until now, according to my colleague who had called me to consult,” Lycette continued in a forceful essay in the New England Journal of Medicine. It’s a meditation on her patient’s death – and what it reveals about the provision of mental health services in rural America:
Her death left me with feelings of profound failure. What good were targeted therapies when her coexisting mental illness prevented her from taking them? And I had been unable to palliate her suffering until her very last days of life. Oncologists don’t just prescribe chemotherapy — a large part of our practice involves caring for people at the end of life. I could not provide that care because I lacked the tools and training to overcome the barrier of mental illness.
The community where I practice mirrors other rural settings in the United States (and globally) in its shortage of psychiatric health care providers. Approximately 4000 Mental Health Professional Shortage Areas were recently identified in the United States, defined as having less than 1 psychiatrist per 30,000 people. When I ran a search of my own county (Clatsop County, Oregon) on the Health Resources and Services Administration website, the table showed me what I already knew: we have 0 psychiatrists per 100,000 people. I recalled a passage from Bryan Stevenson’s book Just Mercy in which he compares expecting people to overcome mental health issues without providing resources to telling people who have no legs that if they can’t climb a flight of stairs they’re lazy.
Lycette has served as the Columbia Memorial Hospital/OHSU Cancer Care Center’s medical director for more than three years through the CMH/OHSU Knight Cancer Collaborative.
Oregon Public Radio recently invited Lycette on the air to talk about her essay. You can listen online to her segment on OPB’s “Think Out Loud” show.