A Rural Doctor Gave Her All. Then Her Heart Broke.

But as the political climate around Covid-19 grew heated, and as some of Dr. 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. More than anything, Dr. Becher was mad at how she couldn’t seem to do anything about any of it. Some days she went home from work, chugged a beer and ran for miles. 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 M.B.I. — is now a scientific standard. Among physicians, a high score on the M.B.I. 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 percent exhibited at least one sign of burnout. A 2019 report by the National Academy of Medicine pointed to studies showing that 54 percent 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, Ala. Many physicians cite these interpersonal connections as the primary reason they go into family medicine. But the sense of dependency can place a significant emotional burden on doctors, Dr. 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.”

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