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Voices: Combating compassion fatigue | Kimberly E. Resnick, MD

Feb 20, 2019

Combating compassion fatigue | Kimberly E. Resnick, MD

“We have not been directly exposed to the trauma scene, but we hear the story told with such intensity, or we hear similar stories so often, or we have the gift and curse of extreme empathy and we suffer. We feel the feelings of our (patients)…Eventually, we lose a certain spark of optimism, humor and hope…We aren’t sick, but we aren’t ourselves.”

-C. Figley, 1995

That beseeching, fearful look. I know this look. These five faces that want answers, any answers—to the complicated scenario I just painted. I glance at my Apple watch. It’s 3:00. Shocked by what we found. Assumed that Ms. X had early stage endometrial cancer.  Had to open due to findings. Stage 4 disease. It’s 3:05.

Kimberly Resnick, MD

My stomach growls. I continue my litany. Couldn’t have predicted this. No way of knowing. No other symptoms. We took out the cancer in its entirety. It’s 3:07. It’s Valentine’s Day. I was in charge of the cupcakes for the Second Grade class party.  I wonder if the boys liked them, wonder if they were too “girlie.” It’s 3:10.

Carcinomatosis, yes, like grains of sand.  More treatment, chemotherapy. At my preoperative counseling I always state that we cannot know the exact stage until we operate, does anyone LISTEN to what I say? It’s 3:12. No, not in the liver or kidneys or rectum.  Yes, I suppose that is good. But truly the horse is out of the barn. It’s 3:14.

I’ve started intermittent fasting as an attempt at self-care and self-preservation. I haven’t eaten in many hours. I’m reviewing the contents of the refrigerator. Thinking about how to make a low glycemic index dinner. It’s 3:16. More therapy will be needed. Yes. Chemotherapy. She is asleep. She doesn’t know this yet. She doesn’t know this yet.

I’m not burned out. I love what I do. Every day. But it’s lurking. At the door. Compassion fatigue.  Mother Teresa knew it well. She mandated that her nuns take a 1 year sabbatical every 4-5 years in order to recover. To heal.  In the stress literature compassion fatigue is known to have a more rapid onset than burnout. Burnout emerges over years…decades.  Compassion fatigue can occur daily when our emotional bank account is literally empty.  Working at the county hospital drains my account daily until…I just…can’t.  The poverty, the chronic illness, psychiatric illness, domestic violence, drug use, lack of resources, lack of support staff—and the cancer—how can I not mention the CANCER?  The stories wash over me like so many ripples in the ocean until I cannot separate them. The sadness abounds.

This is our call to action. Mine and yours.  In every snide comment, every mumble to our nurse about a BMI—we are letting the compassion fatigue get the best of us. Dike Drummond, MD, notes that it is at this point that we need “exquisite self-care.” He suggests:

  1. Cutting hours to a minimum
  2. Only charting what is necessary-step away from the EMR
  3. Take a vacation (or a staycation)
  4. Get rest, get exercise
  5. Spend time with YOUR loved ones

In Judaism “tikkun olam” refers to healing the world.  As doctors this is NOT our task.  We are merely asked to heal one person at a time. The world can wait. Engage in the moment.

  1. Quote by C. Figley-Compassion Fatigue and Psychological Distress Among Social Workers: A Validation Study. Adams, R et al.
  2. Dike Drummond, MD – The Happy MD Blog

Kimberly E. Resnick, MD, is an Assistant Professor at MetroHealth Medical Center in Cleveland, OH.