Wednesday, September 10, 2014

Tapped Out -- Compassion Fatigue

This post is the fourth part in a series on self-care for care-givers. Physicians, nurses, mommas, pastors, teachers and unsung care-givers of every stripe I hope you find something restorative here. Post 1, Caregiver, Love Thyself, Post 2, Thick Line in the Sand, Part 1, Post 3, Thick Line in the Sand, Part 2, Post 4, But...The Lord Told Me To.

This post most closely fits those of you working in caregiving fields. Any work placing you frequently in the middle of others' traumas and problems puts you at risk for something called Compassion Fatigue (CF). Essentially, compassion fatigue is the caregiver's version of burn out. While many caring for children or aging parents experience elements of exhaustion related to that work, this syndrome particularly strikes caregivers who repeatedly encounter others, often at the hardest moments of their lives. Nurses, physicians, pastors & chaplains, counselors, I hope to reach you.

A story
I drove up on a fatal accident this Labor Day. Medical help not yet arrived, I jumped out of the car and approached a red Honda in the center of the road. The man inside needed no medical help. He was dead. I panned the four corners of the intersection, each littered with bystanders, looking for victims. The man's wife was covered in blood, crying in the grass. A quick assessment showed she had no external injuries. The blood was his. She called out for him. I could do absolutely nothing but crawl behind her on the hillside, hold her, and whisper things I don't remember in her ear. When medical services arrived, they took the same path as me. By the car -- help not possible; see bloody victim, approach. And then, as she screamed and cried out information about herself and her fears they yelled, "Ma'am, I need you to calm down." Over and over with this asinine phrase.

I understand the need in chaotic situations to create a presence of assuredness and authority. But this medical professional's response to the tragedy did not create calm. She exuded a detachment beyond that needed to perform her job safely. She demonstrated a need to protect herself from the gory mess on that roadside.

My guess is, she's encountered lots of tragedies that confront her with the fragility and mortality of our species, and the depth of our capacity to ache and grieve. She entered the medical field ready to pour compassion into these circumstances, and having poured it all out long ago, is now going through the motions of a job.

What are we talking about?
Pencil pushers get burn out. Most people who do a repetitive job will eventually, or periodically, experience a loss of meaning in that job. Same thing. Over and over. What's the point? This feeling may wax and wane.

The function of a caregiver's job that is most repetitive is compassion -- or giving of care. When we burn out, it has an extra emotional element to it, because pouring emotion into our job and the people we help is part of what makes us successful, and I'd argue, a fundamental part of how most of us are wired.

We don't just bring our body to our patients, clients, sponsees, or parishioners. We bring our spiritual and emotional selves. Caregiving is life-wide work -- and results in life-wide fatigue. 

Because, as this whole series alludes to, we're not the best at listening to our own voices and symptoms, or providing care to ourselves, we pour out all our resources, blowing past boundaries, not stopping to refill ourselves, and end up empty.

While we got into our work with lofty visions of helping people better themselves, or heal, or grow, we come up against the reality of our limitations, systemic insensitivity, and their unwillingness, and exhaustion and disillusionment set in. We crawl into their pit of despair over and over until emotionally we find our own pit.

So, how do I know?
So how do you know if this is your location? Keep in mind, when others experience trauma, we expect them to need time to process and heal. We often forget that we are vicariously traumatized as we bear witness to the wounds of the people we serve. As you'll see, a couple elements of CF bear resemblance to some PTSD symptoms:
  • Exhaustion -- not just feeling tired. It's bone tired. Heart tired. Weary. Life-wide -- spiritual, emotional, physical.
  • Skipping work
  • Frequent injuries or physical illness
  • Blaming others
  • Irritible -- I got angry at people who needed ordinary things
  • Flashbacks of particular events -- whether visual or auditory
  • Nightmares
  • Poor boundaries -- interesting considering the next point, but we're a sucker for someone who needs us
  • Isolation -- particularly dangerous because it keeps you from building the healthy relationships that counter the unhealth you experience at work
  • Compulsive behaviors or substance abuse
  • Dehumanizing (this is my own addition, based on my experiences and anecdotal research)
Definitely not a complete list, but a good start. I experienced almost all.

A sigh of recognition...
Attending the Rob Bell conference in April, several pastors present shared how they lose sleep thinking about parishioners. They feel tired of caring for people, or reluctant to return to the work, but also feel guilt about this reluctance. They feel a lack of boundaries between them and the problems of people they encounter. I listened as the room seemed to burst with this discussion. Because I've been researching and teaching CF to nurses I knew it strikes any worker for whom compassion is a fundamental function of the role, and others' problems are repeatedly encountered. So, I shared the term and some insight into it with the room. I sensed a spiritual sigh as these caring persons learned a handle -- a name -- for their list of symptoms.

It's important to have words for what we experience. Also, we need to know others go where we go. Normalizing our experience relieves us of the burden to pretend we're fine while secretly wondering if we're crazy.

CF isn't sexy. It doesn't get a lot of play -- even in the medical field. I was preparing to teach leaders in a rural hospital about this topic when a director of my own hospital found out. She rolled her eyes and gave a long "ooookaaay." CF isn't a heart attack. It's a cancer. It takes its time to undermine us, and, at least in the medical field, a mentality blinding us to our need to attend to that slow burn in the bottom of us is elevated as heroic.

Taking action
Three things to do about compassion fatigue: know it exists; attend to it when it happens; engage in preventing it. We covered the first. The second takes time. If you suspect you're experiencing compassion fatigue, I'm about to tell you the thing you least want to hear -- take good care of yourself. Yes, that includes elements of exercise and sleep and healthy eating. But it's not as simple as a list of to-dos. Add to those listening to yourself. Build healthy relationships. Find and engage in community. Talk to people who can validate your experience. Take time to process and review your experiences of others' experiences. Honor the lives you touch, and yourself in this way. These things are nuanced and complicated and the nature of the disease steals your creativity and energy for accomplishing them. It will take a big push to break into what may essentially be brand new, or long lost, behaviors.

Fortunately, preventing compassion fatigue looks a lot like treating it. Easier to learn these behaviors before hand, though. That's why I spend so much time trying to reach students of caregiving fields with this message while they're more malleable to their own efforts to change.

Confession time
That car wreck I told you about? It's eating my lunch. I received huge life-changing news two days before it happened. I was hosting out of town family during this whole time. In that same week, my daughter turned 1, started walking, and we started the process of buying a new home in another town. I'm all kinds of fragmented. The discussion about taking time, honoring your experiences -- yeah, I totally pushed all this away to remain "functional." And now, nearly a week and a half later, I find I'm living in a tiny compartment of myself to avoid the emotional load. I'm doing post-scene what that EMS worker did at the scene.

This style of living doesn't change over night. BUT (beautiful, beautiful 'but'), in the past, I could be months or years down the road before recognizing the change in my walking and breathing and living that comes from this level of experience. I can totally own that I slid into some old patterns of avoiding my truth and ache, while masking that behavior in admirable seeming things like taking care of others. And, I can totally celebrate that I am (emphasis on the on-going process of this) nipping all that craziness in the bud.

I reassert a truth I wrote a couple posts ago: "It's a good, good instinct to love the unlovely, and tend to the broken, and raise the fragile. But, even a good instinct, taken past its usefulness is a breaking thing. If we get lost in every case, there's nothing left of us for our primary responsibilities: self and loved ones. I prioritize self here, because I believe good other care starts with good self care -- not because I'm trying to raise an army of self-absorbed egoists."

The key to loving others well starts with loving me.

For an excellent resource on compassion fatigue, complete with an instrument for rating your level of CF, signs, and tips, visit these lovely people at My email is listed on my "contact" page, so if you don't feel comfortable commenting, but want to share or ask something, feel free to reach out.

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