NEW YORK On an afternoon in early April, while New York City was in the throes of what would be the deadliest days of the coronavirus pandemic, Dr. Lorna Breen found herself alone in the still of her apartment in Manhattan.

She picked up her phone and dialed her younger sister, Jennifer Feist.

The two were just 22 months apart and had the kind of bond that comes from growing up sharing a bedroom and wearing matching outfits. Feist, 47, a lawyer in Charlottesville, Virginia, was accustomed to hearing from her sister nearly every day.

Lately, their conversations had been bleak.

Breen worked at NewYork-Presbyterian Allen Hospital in Manhattan, where she supervised the emergency department. The unit had become a brutal battleground, with supplies depleting at a distressing rate and doctors and nurses falling ill.

When Breen called this time, she sounded odd. Her voice was distant, as if she was in shock.

I dont know what to do, she said. I cant get out of the chair.

Breen was a consummate overachiever, one who directed her life with assurance.

When she graduated from medical school, she insisted on studying both emergency and internal medicine, although it meant a longer residency. She took up snowboarding, cello and salsa dancing as an adult. Once, after she had difficulty breathing at the beginning of a half-marathon, she finished the race, then headed to a hospital and diagnosed herself with pulmonary emboli blood clots in the lungs that can be fatal.

In addition to managing a busy emergency department, she was in a dual-degree masters program at Cornell University.

Breen was gifted, confident, clever. Unflappable.

But the woman speaking to Feist that day was hesitant and confused.

Feist quickly arranged for her sister to be picked up by two friends who would ferry her to Baltimore, where Feist could meet them to take her to family in Virginia. When Breen finally climbed into Feists car that night, she was nearly catatonic, unable to answer simple questions. Her brain, her sister said, seemed broken.

They drove together for a few hours, heading to the University of Virginia Medical Center. When they arrived, Breen checked into the psychiatric ward.

Breen, 49, had suffered a breakdown when the city was desperate for heroes. And she was certain her career would not survive it.

Her family members tried to convince her otherwise. After all, she had no apparent history of mental health problems, and the past month had been one of extremes for everyone.

Breen was doubtful. An insidious stigma about mental health persisted within the medical community.

Lorna kept saying, I think everybody knows Im struggling, Feist said. She was so embarrassed.

Lorna Breen, an athletic and motivated student, headed off to Cornell University to study microbiology before earning a masters degree in anatomy. After medical school in Virginia, she was determined to study two specialties in her residency because she knew emergency doctors suffered high stress. She wanted to have internal medicine as an option down the road.

In 2004, Breen joined the sprawling NewYork-Presbyterian medical system, working at Columbia University Medical Center and the smaller NewYork-Presbyterian Allen Hospital, called simply the Allen.

As if to ensure relief from her intense job, Breen planned thrilling trips, joined a ski club, played cello in an orchestra, took her salsa classes and attended Redeemer Presbyterian, a church that attracted high-achieving professionals.

In 2011, Breen was promoted to the helm of the emergency department, where colleagues said she tended to solve problems with systematic precision and preferred concrete solutions.

She liked structure, said Dr. James Giglio, who was then her boss. She liked working in an organized world.

That world would later distort and crumple. By early this year, the coronavirus was slipping into New York, undetected and underestimated.

In late February, as elected officials were still assuring the public that the virus did not pose a serious threat, Breen sat down at her computer and updated a contingency plan addressed to her family.

She had created it after the Sept. 11 terrorist attacks and revised it after Hurricane Sandy hit in 2012; it was her methodical response to calamity. The coronavirus, she was convinced, would catch hospitals off guard.

A week later, she went on a planned vacation with Feist, her sister, in Big Sky, Montana. By the time Breen returned from the trip, a state of emergency had been declared in New York.

Breen reported back to work March 14, arriving to questions about the departments stock of personal protective equipment and whether staff members could get Tyvek protective suits.

Four days later, Breen showed symptoms of COVID-19. Feverish and exhausted, she quarantined at home to recover. She slept up to 14 hours in a row, was drained by small tasks, lost 5 pounds. But she still tried to sort out work problems, like a shortage of oxygen tanks.

The last weekend in March, Breen went on a walk and felt wiped out. But she told her work she would be back soon. She knew they needed more hands.

When Breen returned to work April 1, the city was on the verge of a grim bench mark: Deaths would soon peak at more than 800 in a single day. The scene at the Allen prompted a disturbing realization: She and her emergency department were outmatched. She called her sister, Feist, upset about the chaos.

Co-workers noted that she looked frazzled. And she was not exuding her usual confidence. Still, she managed that week to call in to a video meeting with her Bible study group. She also reached out to classmates in her postgraduate program, concerned about a group project. She was anxious she was not doing her part.

She started working long days that bled into one another. On April 4, Breen spent about 15 hours at work, according to a colleague.

The following day, she seemed confused and overwhelmed, said the colleague, who had never before seen Breen in such a state. Breen wrote a message to her Bible study group.

Im drowning right now May be AWOL for a while, she typed.

She soon stopped replying to friends messages altogether.

Despite their often hero status, health care workers experience pressure that can be paralyzing. Emergency doctors are particularly vulnerable to post-traumatic stress while working in a profession that encourages toughing it out. The pandemic intensified both the demands made of doctors and the pressure to endure those demands.

When Breen finally called her sister for help April 9, she sounded so unlike herself that Feist wondered if the virus had somehow altered her sisters brain. Although research is still preliminary when it comes to COVID-19s effects on the brain, there is growing evidence that the disease, or the way the body responds to it, can cause a range of neurological issues.

Feist called Dr. Angela Mills, who, as chief of emergency medicine, was Breens supervisor.

When Mills arrived at Breens apartment, Breen looked strange. She was quiet, only speaking when questioned. Even then she gave only one- or two-word answers.

Mills asked if she felt like she wanted to hurt herself. Breen indicated yes.

A friend of Breens who was a psychiatrist arrived to pick her up. After spending some time in the car with Breen, the friend called Feist and said her sister needed to go to the hospital.

Breen spent about 11 days as an inpatient in the psychiatric ward. While in the hospital, she chatted on the phone with her friend Anna Ochoa. Ochoa felt good after hanging up. Her friend seemed strong.

Breen was soon discharged, and she stayed with her mother in Charlottesville, where she was a bit more herself, even making jokes. She mentioned returning to her MBA studies. She started going for long runs. Family members talked about getting her back to New York.

But on April 26, Breen killed herself.

It is impossible to know for sure why someone takes her own life. And Breen did not leave a note to unravel the why.

Still, when the casualties of the coronavirus are tallied, Breens family believes she should be counted among them that she was destroyed by the sheer number of people she could not save, that she was devastated by the notion that her professional history was permanently marred, and mortified to have cried for help in the first place.

NewYork-Presbyterian said in a statement that Dr. Breen was a heroic, remarkably skilled, compassionate and dedicated clinical leader who cared deeply for her patients and colleagues.

If Breen is lionized along with the legions of other health care workers who gave so much maybe too much of themselves, then her shattered family also wants her to be saluted for exposing something more difficult to acknowledge: the culture within the medical community that makes suffering easy to overlook or hide, the trauma that doctors comfortably diagnose but are reluctant to personally reveal.

If the culture had been different, that thought would have never even occurred to her, which is why I need to change the culture, Feist said.

For Breens friend Ochoa, their last conversation has become especially crushing. Ochoa cannot stop hearing Breen repeat: I couldnt help anyone. I couldnt do anything. I just wanted to help people, and I couldnt do anything.

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I couldnt do anything: The virus and an ER doctors suicide - Boston.com