Las Vegas Review-Journal (Sunday)
Doctor gave heart to treating small, W.VA. town during COVID — then it broke
CLAY, W.VA. — For most of her life, Dr. Kimberly Becher has moved fast. She was married at 21, started medical school with a 3-month-old and has trained for two marathons. In the halls of her clinic, between a bank and a Baptist church in Clay — the county seat of Clay County with a population of 396 — she walks fast, often looking down at her phone as she speeds around corners. She talks fast, too, organizing her staff and speaking crisply with a mountain accent.
But her aspect changes when she enters an exam room where a patient is waiting. She slows perceptibly, and the otherwise intense beam of her attention softens.
Recently, Becher, in bright pink scrubs, sat with Zane Wilkinson, 15, who had come in for a monthly checkup with his mother, Julia. He has Behcet’s disease, a rare autoimmune disorder. Zane had been on chemotherapy for five years and had not attended school in person since before the pandemic. But the recent combination of drugs was working well, his mother told the doctor: “He’s almost back to being a normal boy.”
The question in July was whether Zane could safely return to the classroom despite the risk of COVID-19.
“Hoover over Clay?” Becher asked Zane, referring to two nearby high schools that he could attend, Clay County High School and Herbert Hoover High School. Wilkinson, who teaches at Hoover, laughed. “Would you like to talk about that?” she asked Zane.
“No, not really,” he said.
It was the first thing he had said during the visit, and all three of them laughed.
Becher has spent eight years as a family physician in Clay, working for Community Care of West Virginia, a federally qualified health center. West Virginia tops most national lists of poverty and poor health outcomes: the highest prevalence of obesity, coronary disease and diabetes; the fourth-highest poverty rate; the second-highest prevalence of depression; the shortest life expectancy. In Clay County, there is no public transportation, no stoplight, no hospital. Most residents live in a food desert. And as one of only two family doctors in the county, Becher has an all-encompassing job. She visits children in their living rooms to vaccinate them, organizes food drives and administers Suboxone to treat opioid addiction.
But as the political climate around COVID-19 grew heated, and as some of Becher’s patients and neighbors began to dismiss the science, she became frustrated, then angry. She began to run more, sometimes twice a day, for hours at a time, “raging down the road.” She was mad about the widespread distrust of vaccines; mad about teachers who went to school even after testing positive for the virus; mad about the endemic food insecurity, the county’s lack of affordable transportation, the high rate of fatty liver disease.
The indignities layered one atop the next, forming a suffocating stack. Then, on April 17, 2021, her heart broke.
In 1981, two psychologists at the University of California, Berkeley, published a paper in the Journal of Occupational Behavior on “the burnout syndrome.” The authors, Christina Maslach and Susan E. Jackson, set out to measure the degree of stress and emotional exhaustion experienced by professionals like doctors, social workers, therapists and teachers who, they noted, must constantly navigate complicated interactions “charged with feelings of anger, embarrassment, fear or despair.”
Their questionnaire — the Maslach Burnout Inventory, or MBI — is now a scientific standard. Among physicians, a high score on the MBI has been linked to increased errors, decreased patient satisfaction and quick turnover. Burned-out doctors show higher rates of cardiovascular disease, substance abuse and divorce. A 2017 study of about 5,000 physicians published in Mayo Clinic Proceedings found that some 44% exhibited at least one sign of burnout. A 2019 report by the National Academy of Medicine pointed to studies showing that 54% of physicians and nurses were burned out.
“Your patients kind of embrace you as a part of their community; they almost become a part of your family,” said Dr. Tate Hinkle, a family doctor in Lanett, Alabama. But the sense of dependency can place a significant emotional burden on doctors, Hinkle said, especially in isolated rural areas, where chronic illnesses and social disadvantages superimpose: “It just adds that sense of pressure on yourself to make sure you take care of people.”
On that April day in 2021, Becher was at a chess tournament with her teenage son when she suddenly felt as if she were having a heart attack. She left for the emergency room, barely able to see, her blood pressure dangerously high.
Tests soon revealed that she had a rare disease called takotsubo cardiomyopathy, which forces the tip of the heart’s left ventricle to stretch. Most cases occur in older women who have recently experienced some type of intense physical or emotional distress, like the loss of a loved one or a serious accident. It has gained a catchy moniker — broken heart syndrome — but its causes remain unknown.
“The first emotion I felt was actually anger — the very thing that brought me to this cold, hard table,” Becher wrote in a blog post months later. “Quickly the anger faded, and I felt utterly mortified. I wasn’t tough enough to follow the path I’d set myself on.”
Becher grew up in Sissonville, a small community an hour west of Clay. Her aim was to leave West Virginia and never return. Yet in 2014, immediately after finishing her residency, she and her husband and son moved into a house atop a hill in Clendenin, about 30 minutes away from the clinic in Clay. She had $180,000 in debt from student loans.
Becher spent her first years in Clay building up what she called “patient equity.” She slowed down in her characteristic way when talking to her patients and learning about their lives and health issues, which could stem from causes as varied as diabetes, opioid addiction, anxiety, loss of electricity or an old car that had recently broken down. But outside of these interpersonal relationships, she continued apace. She began blogging for the American Academy of Family Physicians, took on advisory roles in local government, increased the number of patients she saw and made more home visits to people unable to drive to the clinic.
I was living in eastern Kentucky at the time, reporting on how the pandemic was affecting food access in Appalachian communities, and on a sunny day that autumn I drove out to talk with her. We met behind her clinic, near a parking lot crowded with cars where a half-dozen nurses were busy administering COVID tests through rolled-down windows. Over the next several days, nearly 200 families would benefit from a food giveaway that Becher had helped coordinate at the high school.
Several months later, early in February 2021, I drove to Clay again. I met Becher in the doorway of her clinic as she was talking to one of her nurses, Cristine Dean. The first COVID vaccine had been released just weeks earlier, and West Virginia had one of the highest vaccination rates in the country; Becher had been helping lead the region’s efforts.
Becher had been working in the clinic seven days a week most weeks, and often stayed up late at her kitchen counter, writing notes on patients’ charts and grant applications for food vouchers. She had begun encountering resistance to COVID science, which added to the strain on her, she said; patients she had seen for years were suddenly questioning her judgment.
In practice, most of Becher’s patients took her advice and got the COVID vaccine. But even as the pandemic introduced an element of distrust to her work, older patients begun coming to her depressed, unable see their children or grandchildren. Becher and Dr. Joanna Bailey, a family doctor in Wyoming County, West Virginia, talked almost every day in a group chat about vaccine distribution, their mounting paperwork and the need to make longterm plans for their communities.
“I’ve felt myself getting angry with a patient over this COVID vaccine,” Bailey told me. “That’s where I decided, I cannot argue about this anymore. I’m going to tell them it’s recommended; I’m going to have my little three lines to say, and that’s it. It’s too big for me.”
But Becher couldn’t let it go. She joined more boards, saw more patients, considered running for a government seat, tried to channel her frustration. 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, he said: “It was like, she was helping people, and if she didn’t do it, then no one would.”
That April, when her heart broke, Becher stopped seeing patients. She quit every board she was on. For a couple of weeks, on bed rest, she tried to figure out what had gone wrong. “Why had I said yes to doing so many home visits?” she later wrote on the blog. “Why did I work so hard to make food accessible in this town that I don’t even live in?” And: “Why did I keep saying yes to everything anyone asked me to do?”
In early 2022, Becher moved to a more administrative role at Community Care of West Virginia and reduced her time in the clinic to one day a week. “I am shifting my focus toward helping other physicians learn from my mistakes, which means I have to actually tell my story,” she wrote in her blog in February. “I am definitely a work in progress, and I am always on the edge of a cliff, at risk of jumping back into being angry and putting myself in a position to be hurt again. But at least now I know there is a cliff.”
On a Friday in late July, Becher invited Dr. Anne Jarrell, a third-year medical resident from East Tennessee State University, to tag along as she worked her day in the clinic. The region had been without a regular family doctor since April 2021, and Becher was hoping that Jarrell, who grew up in West Virginia, could fill that hole.
The next appointment was with a young transgender woman, Dany Frye, whom Becher had been seeing for a couple of years, and who was now weighing the options for surgery.
“Do you have her on hormone therapy?” Jarrell asked. “Yeah,” Becher said. “Awesome,” Jarrell said. “So you do that here?”
“I do that here,” said Becher, who has more than a dozen transgender patients. “I would love it if you came here and did it.”
Although Becher’s most recent echocardiogram was normal and her cardiologist cleared her to exercise regularly again, she had not run since April 2021.
In her new role at Community Care, Becher has been developing a support group for rural physicians through the Robert C. Byrd Center for Rural Health at Marshall University. “She kept all this close to her vest for a long time,” said Jennifer Plymale, the director of the center, who has known Becher since she was in medical school. “But I believe she’s creating a new path for her that’s not all about patient care.”