The Exam Room Diaries: What Doctors Near Bristol Never Chart

Virginia's death customs span the colonial-era Anglican tradition, Appalachian folklore, and African American heritage. In the tidewater plantation communities, historic family cemeteries on private land—many dating to the 17th and 18th centuries—are maintained by descendants who return annually to clean headstones and leave flowers. In the Appalachian communities of southwestern Virginia, traditional death customs include draping the mirror, opening a window to release the soul, and placing coins on the eyes of the deceased before burial. In the African American communities of Richmond, Hampton, and Norfolk, the homegoing tradition features elaborate celebrations with gospel music, community gatherings, and processionals through historically Black neighborhoods.

Virginia's medical heritage is among the oldest in the Americas. The University of Virginia School of Medicine in Charlottesville, founded by Thomas Jefferson in 1825, was the first medical school in the United States to be part of a public university. The Medical College of Virginia (now VCU School of Medicine) in Richmond, established in 1838, performed the first successful heart transplant in Virginia in 1968 and has been a leader in organ transplantation and emergency medicine. The Eastern Virginia Medical School in Norfolk, founded in 1973, became world-famous when Drs. Howard and Georgeanna Jones opened the Jones Institute for Reproductive Medicine and produced America's first in-vitro fertilization baby, Elizabeth Jordan Carr, in 1981.

Walter Reed National Military Medical Center—while now in Bethesda, Maryland—has its roots in Virginia's military medical tradition. The Inova Health System in Northern Virginia is one of the largest healthcare providers in the Washington, D.C., metropolitan area. Virginia's medical history also includes the darker legacy of the Western State Lunatic Asylum (now Western State Hospital) in Staunton, founded in 1828, which operated under the state's eugenics program that sterilized over 8,000 individuals between 1924 and 1979—the constitutionality of forced sterilization was upheld by the Supreme Court in Buck v. Bell (1927), a case originating from the Virginia Colony for Epileptics and Feebleminded in Lynchburg.

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.

The juke joint healers of the Mississippi Delta brought blues music and medicinal whiskey together in ways that echo near Bristol, Virginia. The belief that music could draw out pain—that the right chord progression could realign a dislocated spirit—produced a healing tradition that modern music therapy vindicates. In the Delta, Robert Johnson didn't just sell his soul at the crossroads; he bought back a piece of medicine that the formal profession had forgotten.

The old plantation hospitals that served enslaved populations near Bristol, Virginia are among the most haunted medical sites in America. The suffering that occurred in these spaces—forced medical experimentation, brutal 'treatments,' deliberate neglect—created hauntings of extraordinary intensity. Groundskeepers and historians who enter these restored buildings report physical symptoms: chest tightness, difficulty breathing, and an overwhelming sorrow that lifts the moment they step outside.

County hospitals near Bristol, Virginia serve as unintentional NDE research sites because they treat the most critically ill patients with the fewest resources—creating conditions where cardiac arrests are more common and resuscitation efforts more prolonged. The NDEs reported from these underserved facilities are among the most vivid and detailed in the literature, suggesting that the depth of the experience may correlate with the severity of the crisis.

The Southeast's historically Black medical schools near Bristol, Virginia—Meharry, Morehouse, Howard's clinical rotations—have produced physicians who bring unique perspectives to NDE research. The Black near-death experience, influenced by African diasporic spirituality, often includes elements absent from the standard Western NDE model: ancestral encounters, communal rather than individual judgment, and a return motivated by obligation to the living.

High school football in the Southeast near Bristol, Virginia is more than sport—it's community identity. When a Friday night quarterback suffers a career-ending injury, the healing that follows involves the entire town. The orthopedic surgeon, the physical therapist, the coach, the teammates, the church—all participate in a recovery process that is simultaneously medical, social, and spiritual. In the South, healing is a team sport.

The screened porch—ubiquitous across the Southeast near Bristol, Virginia—has served as a healing space since the days when tuberculosis patients were prescribed fresh air. Modern physicians who recommend time outdoors for depression, anxiety, and chronic pain are rediscovering what Southern architecture always knew: the boundary between indoors and outdoors, when made permeable, promotes healing that sealed buildings cannot.

The concept of "death by a thousand cuts" has been applied to physician burnout by researchers who argue that it is not any single stressor but the cumulative effect of countless minor frustrations that drives physicians out of medicine. Dr. Christine Sinsky, vice president of professional satisfaction at the AMA, has documented the "pebbles in the shoe" of daily practice: the EHR login that requires multiple passwords, the prior authorization fax that goes unanswered, the policy that mandates documentation of a negative review of systems for every visit, the meeting that could have been an email. Each pebble, taken individually, is trivial. Collectively, they create an environment so friction-laden that the fundamental acts of medicine—listening, examining, diagnosing, treating—become secondary to the administrative apparatus that surrounds them.

Sinsky's ethnographic time-motion studies, published in the Annals of Internal Medicine, provide the most granular data available on how physicians in Bristol, Virginia, and nationwide actually spend their time. The findings are sobering: for every hour of direct patient care, physicians spend nearly two hours on EHR and desk work, with an additional one to two hours of after-hours work at home. These ratios invert the purpose of medical practice—the physician exists to serve the record, not the patient. "Physicians' Untold Stories" represents a conscious inversion of this inversion. Dr. Kolbaba's accounts center the patient encounter—in all its mystery and wonder—as the irreducible core of medical practice, reminding physicians that the pebbles, however numerous, cannot bury the bedrock.

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 Bristol, Virginia, 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 Bristol, Virginia, 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.