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In this commentary, the authors offer a call to action in the long-standing fight to prevent clinicians from dying by suicide. In April 2020, the nation was shocked by the suicide of New York City emergency physician Dr. Lorna Breen, who died while recovering from COVID-19. She joins an unknown number of clinicians who have taken their lives over the past year. The authors introduce Dr. Breen, a highly talented physician working on the frontlines of the COVID-19 pandemic, and examine how pervasive distress and suicide are in clinicians. Then, they explain the lived experience movement and highlight how clinicians speaking openly about their mental illness and treatment are making it easier for their colleagues to seek lifesaving help, despite the stigma still surrounding mental illness and treatment in medicine. The authors sort through the science of clinician distress; critique how the COVID-19 pandemic is affecting the lives of clinicians; and describe existing national initiatives to address clinician stress, burnout, and suicide. Finally, they recommend evidence-based actions to prevent clinician suicide that multiple stakeholder groups can take, including regulatory agencies, licensing boards, and hospital privileging boards; specialty boards, professional associations, and continuing education organizations; medical educators; and individual clinicians. Suicide is a complex but generally preventable cause of death. Those in medicine must forge ahead with collective momentum. Dr. Breen, so many other clinicians, and those they have left behind deserve nothing less.

To reduce the risk of infections associated with indwelling central venous catheters (CVCs), practices for hub disinfection have been widely promoted. The objective of this study was to design and implement a standardised tool to monitor compliance with 'scrub the hub' practices at an Australian centre.Review of existing literature and recommendations regarding scrub the hub practices was performed to identify nine key components that could be audited by direct observation of staff in clinical areas. The tool was reviewed by stakeholders in infection prevention, infectious diseases and senior nursing roles prior to pilot evaluation.Twenty attempts to access a CVC were audited. In all instances, scrub the hub practices were commenced. However, a 15-second scrub was performed in only 60% of cases, and the hub was permitted to dry in only 65% of instances. With respect to maintaining an aseptic field, the overall compliance was 40%, and compliance was lowest for maintenance of a non-touch technique for key parts and sites, and hand hygiene practices following CVC access.A standardised clinical audit tool for monitoring aseptic access of CVCs enabled identification of practices amendable to targeted intervention and education, such as duration of hub disinfection. This tool would be readily utilised to facilitate quality improvement initiatives in a range of healthcare contexts, including high-risk inpatient and ambulatory care settings.

Highlights National recommendations are for 2 influenza vaccine doses in immunocompromised patients receiving vaccine for the first time. We report experience in implementing a nurse-led vaccination program for ambulatory immunocompromised patients with cancer. 44/183 (24.0%) patients were vaccine-naive, with 1 of the 2 vaccines administered by a general practitioner in 11 instances. Optimally, hospital programs for influenza vaccination of cancer patients must also engage primary care clinicians.

The representation by male authors of relations between European women and black men in fiction is often stereotypically favourable to the imaginative interests of men. V. S. Naipaul’s The Mimic Men (1967), for example, epitomises a masculine conception of a mixed-race marriage in which the female European partner, Sandra, is portrayed as the cynical and knowing vamp, who entraps sexually the naive and misguided Indian student narrator: She had failed a qualifying examination for the second time. That was the end of her government grant, the end of the School. No degree for her now; no escape by that route … What awaited her? The secretarial course, the librarian’s course, the common employer. She went on, railing at her society, bitter at her lack of protection and patrons within it. A job in the bank; the typing pool; the Woolworth’s counter. She was working herself up to a pitch of hysteria. Tears of anger came to her eyes. Then suddenly, fixing those moist eyes on me, she said, almost ordered, with a look of total hatred: ‘Why don’t you propose, you fool?’ … for the first time since our talk had begun, I thought of her painted breasts.1

Masculine responses in fiction to the gestation and delivery of babies are few. William Blake, however, in ‘Infant Sorrow’ (Songs of Experience, 1794), gives a lyrical representation of childbirth from the point of view of the baby. The emergence from secure womb to ‘dangerous world’; the travails of the mother; the emotionality of the father; the feeling of being circumscribed by restrictive clothing; the sulking upon the ‘mother’s breast’ — Blake encapsulates what the psychoanalyst Carl Rogers called the ‘birth trauma’. But the word ‘trauma’ — ‘emotional shock’ (The Concise Oxford Dictionary) — exaggerates what is after all only a stage in growth.