Behind Closed Doors: Physician Stories From Milwaukie

Oregon's death customs reflect its progressive culture and deep connections to the natural environment. The state's Death with Dignity Act, passed in 1994, created a legal framework for physician-assisted death that has influenced end-of-life law nationwide. Oregon was also the first state to legalize human composting (natural organic reduction) as a burial alternative in 2021, reflecting Oregonians' environmental values. In the state's fishing communities along the coast, maritime memorial traditions include scattering ashes at sea and placing memorial wreaths in harbors. The Confederated Tribes of Warm Springs maintain traditional burial practices that honor the deceased's connection to the land, including placing grave goods of salmon, roots, and berries alongside the body.

Oregon's medical history begins with the physicians who accompanied the Oregon Trail migrations in the 1840s. The Oregon Health & Science University (OHSU) in Portland, established in 1887 as the University of Oregon Medical School, sits atop Marquam Hill and has become the Pacific Northwest's leading academic medical center. OHSU gained national recognition for its work in neonatal medicine—Dr. Lois Johnson pioneered surfactant therapy for premature infant lung disease—and for establishing one of the first comprehensive cancer centers on the West Coast, the OHSU Knight Cancer Institute, which received a transformative $500 million donation from Nike co-founder Phil Knight in 2013.

Oregon has been a leader in end-of-life care legislation. In 1994, Oregon voters passed the Death with Dignity Act, making it the first U.S. state to legalize physician-assisted death for terminally ill patients. This landmark law fundamentally changed the national conversation about end-of-life autonomy. Providence Health & Services, rooted in the arrival of the Sisters of Providence in Oregon in 1856, grew from St. Vincent Hospital in Portland into one of the West Coast's largest health systems. The Oregon State Hospital in Salem, the setting of Ken Kesey's 1962 novel 'One Flew Over the Cuckoo's Nest,' has a complex history spanning from its 1883 opening through controversies over patient treatment to its modern rebuilding completed in 2011.

The United States has been at the forefront of medical innovation since the 18th century. Massachusetts General Hospital in Boston performed the first public surgery using ether anesthesia in 1846 — an event known as 'Ether Day' that changed surgery forever. The 'Ether Dome' where it occurred is still preserved.

Bellevue Hospital in New York City, established in 1736, is the oldest public hospital in the United States. The Mayo Clinic in Rochester, Minnesota — where Dr. Scott Kolbaba trained — was founded by the Mayo brothers in the 1880s and pioneered the concept of integrated, multi-specialty group practice that became the model for modern healthcare.

The first successful heart transplant in the U.S. was performed in 1968, and American institutions have led breakthroughs in everything from the polio vaccine (Jonas Salk, 1955) to the first artificial heart implant (1982). Today, the National Institutes of Health in Bethesda, Maryland, is the world's largest biomedical research agency.

The United States has one of the world's richest ghost story traditions, rooted in a blend of Native American spirit beliefs, European colonial folklore, and African American spiritual practices. From the headless horseman of Sleepy Hollow — immortalized by Washington Irving in 1820 — to the restless spirits of Civil War battlefields at Gettysburg, American ghost lore reflects the nation's turbulent history.

New Orleans stands as the undisputed spiritual capital of American ghost culture, where West African Vodou merged with French Catholic mysticism to create a tradition where the boundary between living and dead remains permanently thin. The city's above-ground cemeteries, known as 'Cities of the Dead,' are among the most visited supernatural sites in the world. Marie Laveau, the Voodoo Queen of New Orleans, is said to still grant wishes to those who mark three X's on her tomb.

Appalachian ghost traditions draw from Scots-Irish folklore, with tales of 'haints' — restless spirits trapped between worlds. In the Southwest, Native American traditions speak of skinwalkers and spirit animals, while Hawaiian culture reveres the Night Marchers — ghostly processions of ancient warriors whose torches can still be seen along sacred paths.

The United States has documented numerous cases of unexplained medical recoveries. In Dr. Kolbaba's own book, a physician describes a patient declared brain-dead who suddenly recovered after family prayer. The Lourdes Medical Bureau has certified one American miracle cure. Cases of spontaneous remission from terminal cancer have been documented at institutions including MD Anderson Cancer Center and Memorial Sloan Kettering. The National Library of Medicine contains over 1,000 published case reports of 'spontaneous remission' across various cancers and autoimmune diseases — recoveries that defy current medical explanation.

Old sanitarium hauntings near Milwaukie, Oregon connect the Pacific Northwest's tuberculosis history to its present-day medical culture. The sanitariums built on hillsides above Portland, Seattle, and Tacoma to catch the healing sea air housed patients who spent months or years coughing blood into white handkerchiefs. Their ghosts cough still, and respiratory therapists in the region report hearing phantom coughs in empty rooms with a frequency that exceeds statistical chance.

Japanese American fishing communities near Milwaukie, Oregon were devastated by internment during World War II, their boats confiscated and their livelihoods destroyed. The ghosts of fishermen who died during or after internment appear at Pacific Northwest hospitals with the stoic endurance that characterized their community's response to injustice. These ghosts carry fishing nets and determination in equal measure.

The Pacific Northwest's mindfulness culture near Milwaukie, Oregon—rooted in the region's strong Buddhist and secular meditation communities—produces a population unusually skilled at introspective reporting. NDE experiencers with meditation backgrounds provide accounts of exceptional detail and nuance, distinguishing between layers of experience that untrained observers merge into a single narrative. The meditator's NDE report is the richest data point in the researcher's dataset.

The Pacific Northwest's tradition of literary naturalism near Milwaukie, Oregon—from Jack London to Sherman Alexie—provides a cultural context for receiving NDE accounts that emphasizes accuracy and unflinching observation. Pacific Northwest readers and physicians approach NDE reports the way they approach nature writing: with respect for the phenomenon described, a demand for precise language, and an unwillingness to romanticize what is essentially a description of dying.

The Pacific Northwest's coffee culture near Milwaukie, Oregon—the ritualized daily gathering over carefully prepared beverages—serves a healing function that goes beyond caffeine. The neighborhood coffee shop is where isolated individuals find community, where grieving people receive unsolicited kindness, and where the Pacific Northwest's famous reserve softens into genuine connection. The barista who remembers your name is practicing a form of care.

The Pacific Northwest's tradition of communal sauna near Milwaukie, Oregon—influenced by Finnish, Russian, and Native American sweat traditions—provides a healing ritual that combines heat therapy, social connection, and the psychological reset of extreme temperature contrast. Communal saunas near hospitals serve as recovery spaces where patients, families, and staff share an experience that dissolves social hierarchies and promotes physiological healing.

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 Milwaukie, Oregon, 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 Milwaukie, Oregon, 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.

The impact of burnout on physician families has received increasing attention in recent literature. A study published in the Annals of Family Medicine found that physician burnout is significantly associated with relationship distress, with burned-out physicians reporting higher rates of marital conflict, emotional withdrawal from their children, and overall family dysfunction. The study also found that physician spouses reported elevated rates of depression and anxiety, suggesting that burnout is 'contagious' within families. For the families of physicians in Milwaukie, Dr. Kolbaba's book serves a dual purpose: it helps the physician reconnect with the meaning of their work, and it helps family members understand the extraordinary — and extraordinarily difficult — nature of what their loved one does every day.