Monday, August 8, 2011

Compassion Fatigue

I was reading The Homeless Parrot's post about the heatstroke dog and the idiots who claim to care. For some reason, the post finally made me able to somewhat put into words the battle inside me over the past 4 years since I graduated and started to practice.

Technically, they call it compassion fatigue but that seems a really lame term for the feeling. Incidentally, I found it telling that there were lectures for technicians but none for veterinarians on the subject at the AVMA meeting. For me, I remember very vividly a case that I saw on my terminal preceptor just before graduation that was one of many that set off the downward cascade. It was a 2y old Dachshund that had intervertebral disk disease (presumptively) whose owners could not afford referral therefore we attempted medical management. Like always, I poured heart and soul into the dog, pulling out all the stops. It was a long road and just as the dog turned the corner and began to take a few ataxic steps on its own with no support, the owners opted to euthanize. They, it seemed, were not ready to pour heart and soul into the dog; they decided that they couldn't face the possibility of going through the same thing again. They didn't even come to say goodbye. I took the dog outside and fed him treats as I injected the fatal solution to the world's ills. He died sitting in my lap on the grass, eating (his favorite pastime).

I could relate dozens of these stories. Point is that the fact that the empty feeling grows daily and has followed me from job to job proves to me it is not simply job burn out. I find it harder and harder to give so much of myself on each patient. It used to be a nonentity; something I didn't even think about, I just did. Now, there are times when I have the shocking feeling that I just don't even care. I feel as if my emotions are cauterized. (Not talking about my own children, I would move heaven and earth if I could to do for them. It's just really hard to continue to drain oneself by caring so much when you can do nothing primarily because the owner won't let you.) This has been progressively building over time. I sound as if I'm saying everyone is that way, which is not true, it just seems that the majority of people I deal with are. I understand financial concerns; heck, I'm struggling to make ends meet at the moment, too. The necessity of caring for the herd, however, is the sole reason I have a credit card and have credit card debt at the moment. And it seems as if many of the people who will do nothing do not make the decision because of money but because they are too stingy to spend any on the animal.

If this continues, I think I'll seriously have to look at another work venue because I don't think I can live with myself not caring. Needless to say, it's worse right now, too. Each morning I put on a professional mask in order to function at work all the while questioning what I could have done differently for my dog and listening to people turn down even simple care that could vastly improve their pet's life. Blaming myself for my loss while fielding calls from clients who took their overweight dog out to exercise in the heat of the day (did I mention this is northeast Alabama where we are in the middle of a heat wave with heat indices in the triple digits?) and it died of heat stroke because we recommended it needed to lose weight therefore it is clearly our fault their dog died. Compassion fatigue? It really doesn't seem to be a strong enough description. Emotional burnout? Cauterized caring? What is the word for the disease in which people are incapable of feeling pain? Maybe some derivative from that would be a better description. Or maybe there is just no way to describe it until you experience it...


Fi from Four Paws and Whiskers said...

I am really sorry to read this - it is a tragedy of this profession that we have to endure our patients dying this way... most doctors do not have to regularly kill their patients.
We certainly did not train for all that time just to face these issues, but as credit squeeze reduces disposable income, too many clients walk away from paying. They just hope it will never be need to be spent.... and accept that some pets will be euthed quickly in the event of any injury or disease.

If we lose good vets, ones who do actually care, even if you are currently numb, then only the hardened bitter and insensitive ones will be left, which is not fair on the pets who are actually treated.
I can't change anything
but I hear you.

VetVoyeur said...

I also am sorry to read this, but I understand the feelings because they are rampant in my field also. Since starting to follow vet blogs I have been horrified at the stories of outright owner cruelty and lack of caring. Whatever it takes, I hope you, and the other vets I follow, can find ways to leave work at work and refresh yourselves and your commitment to your work. Clients like me, who are dedicated to our animals, need vets like you who are invested and care enough to help us make informed and thoughtful decisions for our best friends. And I thought being a counselor was a burn-out profession! VV

Leore_Joanne said...

Maybe you just need a little break from it, just to recharge yourself. It sounds like this is something that is very important to you, even if you feel desynthesized at the moment.
I can't give any help with my experience since I have none, I haven't even started vet school yet, Ive only been rescuing animals on my own for now, and the first time I met the sort of owner you talked about was two months ago when I realized that my neighbour's cat is growing thin, has mites in her ears, and has scratched herself to the point of bleeding and pus filled wounds. When I went to talk to the neighbour, which I did very kindly and non-accusingly, she said that it isn't her problem, that she basically doesn't care, and that maybe the cats just needs to be put down. I went away speechless. Ever since then I have been checking on the cat periodically and treating her ears.
I can only imagine what it is like to deal with this sort of stuff every day, but not all the cases are like that, right? there must be cases that remind you why you love doing this - for the animals, in spite of sometimes stupid owners.

Hope you feel better.

Anonymous said...

I've been thinking about your post. trying to come up with something witty and revealing. However realistically when you are passionate about what you do and your level of expectation time and time again appears too high everyone gets deflated. unfortunately the grass is NOT greener on the otherside you just get a different set of variables to juggle until the same problem occurs again. I don't know what the solution is? After giving up a career in healthcare to work with machines that pang is still there. Now I just try to find a small corner in what you do that meets your expectations whenever you need it. It could be another member of the staff that you work with who never lets you down. It can be the person you see daily at teh coffee shop. whatever or whomever is that little bright light in your day needs to be looked at and valued for just a few moments. Yes there may be extremely happy/fulfilled people out there. Yay for them. and perhaps you'll become one of them. but for now being numb to the world may help you cope a little but try to find that little teeny tiny bright spot.

Shawn Finch, DVM said...

Hey Doctor, it is called "This Sucks" and there is not a cure. But you are kind and compassionate, and do whatever it takes to hold on to that. I don't really know what it is called :) but I feel that way too, sometimes more than others.

I am so sorry about your Rusty Dog. Losing a friend multiplies that "compassion fatigue" and it will be a long, slow road of healing.

Hmm, I am not very encouraging. Should have just said "I hear you" too. I do.