Secrets of the ER: Physician Stories From Alaverdi

Georgia has a medical history that blends ancient healing traditions with modern medical achievement. Georgian traditional medicine includes an ancient pharmacopoeia based on the country's remarkable botanical diversity — the Caucasus region is one of the world's biodiversity hotspots — and the therapeutic use of mineral and sulfur springs that has been practiced for millennia. The Tbilisi sulfur baths, which drew visitors from across the Caucasus and the Middle East, were among the most famous therapeutic sites in the region. The medieval Georgian medical tradition, influenced by both Byzantine and Persian medicine, produced sophisticated medical texts.

Modern Georgian medicine has been shaped by the Soviet healthcare system, which despite its many flaws provided universal access and trained a large number of physicians. Tbilisi State Medical University, founded in 1918, is one of the oldest medical schools in the Caucasus. Georgian physicians have made contributions to fields including phage therapy — the use of bacteriophages to treat bacterial infections — which was pioneered at the Eliava Institute of Bacteriophage, Microbiology and Virology in Tbilisi, founded in 1923 by the Georgian microbiologist George Eliava. As antibiotic resistance has become a global crisis, Georgia's phage therapy expertise has attracted renewed international attention.

Georgia's (the country in the Caucasus) spirit traditions reflect one of the world's oldest and most deeply rooted Christian cultures, combined with pre-Christian Caucasian beliefs that have survived in the mountainous regions for millennia. Georgia adopted Christianity as its state religion in 326 CE — making it one of the first nations in the world to do so — and the Georgian Orthodox Church has profoundly shaped the nation's relationship with the supernatural. Georgian folk Christianity maintains beliefs about angelic beings, demonic entities, and the active presence of saints that blend official theology with ancient Caucasian spiritual traditions. In the mountain regions of Svaneti, Tusheti, Khevsureti, and Pshavi, pre-Christian nature spirits and deities have been syncretized with Christian saints, creating a unique spiritual landscape.

The practice of kidveba (calling the dead) exists in Georgian folk tradition, in which the spirits of the recently deceased are believed to return to their families during specific rituals. The supra — Georgia's famous ritualized feast — traditionally includes toasts to the dead (modzmalo!), and the tamada (toastmaster) serves as a bridge between the living and the deceased during these ceremonies. Georgian funeral traditions are elaborate, and the mourning period includes specific rituals at which the deceased's spirit is believed to be present.

In the mountainous regions, the tradition of jvari (sacred cross shrines) combines Christian symbolism with pre-Christian sacred sites, creating locations of intense spiritual power where villagers communicate with both God and the spirits of their ancestors. The Svan people of Upper Svaneti maintain particularly archaic spiritual practices, including rituals conducted at ancient stone towers that have been used for both defensive and spiritual purposes for a thousand years. The tradition of curative thermal springs, particularly in Tbilisi (whose name derives from the old Georgian word "tbili," meaning "warm," after its sulfur springs), has ancient roots in both the physical healing and spiritual renewal associated with sacred waters.

Georgia's miracle traditions are deeply embedded in its 1,700-year Christian heritage. The country's churches and monasteries are associated with numerous miracle accounts, from the founding legends of ancient churches — such as the story of the Svetitskhoveli Cathedral in Mtskheta, built on the site where Christ's robe was allegedly buried — to contemporary reports of weeping icons and miraculous healings. The Tbilisi sulfur baths have been credited with remarkable cures for centuries, combining their documented therapeutic properties (for skin conditions, arthritis, and other ailments) with spiritual associations that elevate the bathing experience to a healing ritual. The Georgian Orthodox tradition of myrrhstreaming icons — icons that are reported to exude a fragrant oil with healing properties — has produced accounts of miraculous recoveries. Traditional Georgian medicine, including the use of Caucasian herbs, honey, and wine for therapeutic purposes, has also generated accounts of remarkable cures, particularly in the mountain communities where access to modern medicine has historically been limited.

Community hospitals near Alaverdi, Kakheti anchor their towns the way churches and schools do, providing not just medical care but economic stability, community identity, and a gathering place for shared purpose. When a rural hospital closes—as hundreds have across the Midwest—the community doesn't just lose healthcare. It loses a piece of its soul. The hospital is the town's immune system, and its absence is felt in every metric of community health.

Hospital gardens near Alaverdi, Kakheti planted by volunteers from the Master Gardener program provide healing spaces that cost almost nothing but deliver measurable benefits. Patients who spend time in these gardens show lower blood pressure, reduced pain medication needs, and shorter hospital stays. The Midwest's agricultural expertise, applied to hospital landscaping, produces therapeutic landscapes that pharmaceutical companies cannot replicate.

The Midwest's tradition of hospital chaplaincy near Alaverdi, Kakheti reflects the region's religious diversity: Lutheran chaplains serve alongside Catholic priests, Methodist ministers, and occasionally Sikh granthis and Buddhist monks. This diversity, far from creating confusion, enriches the spiritual care available to patients. A dying farmer who says 'I'm not sure what I believe' can explore that uncertainty with a chaplain trained to listen rather than preach.

The Midwest's tradition of bedside Bibles near Alaverdi, Kakheti—placed by the Gideons in hotel rooms and hospital nightstands since 1899—represents a passive faith-medicine intervention whose impact is impossible to quantify. The patient who opens a Gideon Bible at 3 AM during a sleepless, pain-filled night and finds comfort in the Psalms is receiving spiritual care delivered by a book placed there by a stranger who believed it would matter.

The German immigrant communities that settled the Midwest brought poltergeist traditions that manifest in hospitals near Alaverdi, Kakheti as unexplained object movements. Surgical instruments rearranging themselves, bed rails lowering without anyone touching them, IV poles rolling across rooms on level floors—these phenomena, dismissed as coincidence individually, form a pattern that Midwest hospital workers recognize with weary familiarity.

The Dust Bowl drove thousands of Midwesterners from their land, and the hospitals near Alaverdi, Kakheti that treated dust pneumonia patients carry the memory of that exodus. Respiratory therapists in the region describe occasional patients who cough up dust that shouldn't be in their lungs—fine, red-brown Oklahoma topsoil in the airway of a patient who has never left Kakheti. The land's memory enters the body.

The pharmacology of physician distress—the substances physicians turn to when burnout exceeds their coping capacity—has been studied with increasing rigor. Research published in the Journal of Addiction Medicine estimates that substance use disorders affect 10 to 15 percent of physicians over their lifetime, with alcohol being the most commonly misused substance, followed by prescription opioids, benzodiazepines, and stimulants. Physicians have unique risk factors for substance misuse: easy access to medications, high-stress work environments, the self-medicating tendencies that medical knowledge enables, and the stigma that prevents treatment-seeking. State physician health programs (PHPs) provide monitoring and treatment, but participation is often mandatory following disciplinary action rather than voluntary.

The neurobiology of substance use and burnout share overlapping pathways: both involve dysregulation of dopaminergic reward circuits, stress-hormone systems, and prefrontal executive function. This overlap suggests that addressing burnout proactively could reduce substance use risk. "Physicians' Untold Stories" offers a non-pharmacological alternative pathway for emotional regulation. For physicians in Alaverdi, Kakheti, who may be at risk for substance misuse, Dr. Kolbaba's extraordinary accounts provide experiences of wonder and meaning that naturally engage the brain's reward systems without the risks of chemical self-medication—a subtle but potentially significant protective factor.

Physician suicide represents the most catastrophic outcome of the burnout epidemic, and the data are sobering. An estimated 300 to 400 physicians die by suicide annually in the United States, a rate that is 1.41 times higher than the general population for male physicians and 2.27 times higher for female physicians, according to research published in the American Journal of Psychiatry. The absolute numbers, while tragic, likely undercount actual physician suicides due to underreporting, misclassification, and the reluctance of medical examiners to assign suicide as cause of death for colleagues. Importantly, physician suicide is not primarily a function of untreated mental illness—many physicians who die by suicide were functioning at high levels professionally, masking their distress behind clinical competence.

The Dr. Lorna Breen Health Care Provider Protection Act (Public Law No. 117-105), signed in March 2022, addresses some structural barriers. It funds training programs to improve mental health awareness, allocates grants for evidence-based wellness interventions, and includes provisions to reduce stigma associated with mental health treatment-seeking among healthcare workers. For physicians in Alaverdi, Kakheti, this legislation represents a meaningful step, but legislative change without cultural transformation is insufficient. Dr. Kolbaba's "Physicians' Untold Stories" contributes to cultural transformation by validating the emotional dimensions of medical practice that the profession's stoic culture has suppressed—dimensions whose suppression contributes directly to the despair that drives suicide.

The Dr. Lorna Breen Heroes' Foundation, established by Dr. Breen's family following her death by suicide on April 26, 2020, has become the most visible advocacy organization addressing physician mental health in the United States. The foundation's efforts have been instrumental in several concrete policy achievements: the passage of the Dr. Lorna Breen Health Care Provider Protection Act, successful advocacy campaigns to remove or modify mental health disclosure questions on state medical licensing applications (with 27 states having made changes as of 2024), and the development of educational resources addressing stigma, help-seeking, and systemic burnout drivers.

The foundation's approach is notable for its emphasis on systemic rather than individual solutions. Rather than urging physicians to "seek help," the foundation advocates for removing barriers to help-seeking and restructuring the environments that create the need for help in the first place. For physicians in Alaverdi, Kakheti, the foundation's work has tangible local relevance: changes in licensing board questions may directly affect local physicians' willingness to seek mental health treatment. "Physicians' Untold Stories" supports the foundation's mission by contributing to the cultural shift it advocates—a shift toward acknowledging that physicians are human, that their emotional responses to extraordinary clinical experiences are assets rather than liabilities, and that the work of healing exacts a toll that deserves recognition, not punishment.