It was close to 2 decades ago, but it is still as clear as if it had been yesterday. I sat in the intensive care unit, fresh from my residency, tears streaming down my face, which was firmly nestled between my hands as I tried to hide my pain from every soul around me – doctors, nurses, patients’ family members – anyone and everyone.
I had just lost a very dear patient and emotions were running high. I only hoped no one at the nurses’ station would notice me, at least until I had a chance to regain my composure. After all, who would expect to see, or even respect, a doctor found sobbing like a child over a patient who died? Isn’t that all part of the job? Don’t we anticipate the death of some of our most critically ill patients?
Almost paralyzed with grief, I had a hard decision to make.
Option one: I could sit firmly planted in my seat and deal with my personal loss, the loss of my patient with chart number 0001 – yes, my very first patient in private practice. Over time, she and I had developed a very warm, loving relationship, almost like that of a mother and daughter as she was several decades my elder. I had a right to grieve my loss just as anyone else would grieve after losing someone they cared for, didn’t I?
Option two: I could bury my personal feelings and deal with them later in the comfort of my home, safe from the incessant pages from nurses calling about other patients’ urgent needs, hidden from accusing, sometimes condescending glances from other medical professionals who could never understand why I would react so strongly to the death of a patient – especially in a place surrounded by the watchful eyes of others who hold physicians to such a high standard.
Not so much to save face, but for the sake of other critically ill patients who needed a calm, clear-thinking physician to make prudent decisions regarding their care, I chose option two.
As hospitalists, our work is exciting and extremely rewarding, yet with all the suffering and death we see, we must be very careful to guard our hearts and minds, lest we fall into a state of perpetual inner turmoil and stress, and find ourselves seeking counseling or even prescription medication to cope. Compassion satisfaction and compassion fatigue are two ends of a spectrum that caregivers, including medical professionals, often experience. As the names suggest, the former refers to the positive feelings of helping others in need, while the latter refers to a potentially pathologic psychological adaptation to the suffering we experience.
Dr. Charles Figley, director of the Tulane Traumatology Institute in New Orleans, describes compassion fatigue as “a state experienced by those helping people or animals in distress; it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper.”
We all have different coping mechanisms. Some hospitalists are so focused on the art of healing the sick that they have learned to dissociate themselves from the suffering of the individuals they serve, while still delivering excellent care to each and every patient. Not everyone has reached that level.
“Striking the right work-life balance helps me,” said Dr. Marianne Cunanan-Bush, medical director of the inpatient team at Baltimore Washington Medical Center in Glen Burnie, Md. “The first part of my day is spent in personal quiet time, [so] I can just relax and let my mind go free. And my family life is vital. My husband and I play tennis with our children and do other fun things as a family and that helps keep me grounded.”
Dr. Jiayan Chen, a hospitalist at Baltimore Washington Medical Center, finds it almost impossible to completely avoid compassion fatigue. “As hospitalists, I think we can only try to minimize it,” she said. “Try to be sympathetic to patient and family but remain neutral to avoid too high compassion fatigue. Talk to colleagues a couple of times a day, give yourself a few small breaks, including lunch time, drink a cup of water, anything to help break the tension of care during the day.”
Whatever your personal style or inner make-up, be true to yourself. It’s okay to be stoic and to cry sometimes, but if you need help dealing with the trauma and stress this profession sometimes brings, don’t be ashamed to seek the counsel of friends, family members, or even professionals. Two useful resources for help in dealing with, and preventing, compassion fatigue are the Compassion Fatigue Awareness Project and ProQOL.org .
Those of you with small children will appreciate this more than others: As the words of a popular song sung by little girls from coast to coast say, “Let it go, let it go. Don’t hold it back anymore!”
Dr. Hester is a hospitalist at Baltimore Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at firstname.lastname@example.org .