Re-Post Of Compassion Fatigue blog.

In light of the publishing of NPR's article on compassion fatigue, I thought I would re-post the original, unedited blog written almost 3 years ago. It was one of the few blogs that came to me in a downpour of words compelled to put to paper. Written in an hour it is one of the most honest genuine pieces I have ever produced (next to those on Savannah).

I can say things have gotten better. I know who I am and who I protect her inside. I accept the struggle and forgive more readily. I let go from the things I cannot change more easily and I listen to the voice that reminds me that giving is a gift, not a burden. I am less afraid and more empowered. I embrace the challenges instead of wishing it could be easier. I smile, hug my pets and am thankful for the good friends in my life.. I try to chose to cherish instead of grieve.  

To those struggling you are never alone. 

Compassion Fatigue. When the candle you are burning at both ends consumes you.

“The Lord giveth and the Lord taketh away.”  BUT in the case of our pets,  should it be “the Lord giveth and the vet taketh away?” How does the responsibility, the quest for providing a service, and the weight of the burden that this profession puts upon you keep you from becoming exhausted? And how does the emotional stress not accumulate to the point where that stress breaks you?

In the trade we coin it “compassion fatigue.”

It is the burden of the beast.

I read somewhere that something like one-third of US women are on some sort of tricyclic antidepressant. If the general public can’t make it through their normal day without some help how is our profession not supposed to end up not heavily self- medicated, depressed, or seeking a way out from under the mountain of emotional turmoil and  strain?

There is a common belief amongst vets that our profession has the highest suicide rate. We know what death from the end of hot pink syringe looks like. We talk about ‘quality of life,” “making hard decisions,” “letting go,” “saying goodbye,” and ending suffering” enough times to almost believe it ourselves.  And there is a knowing that if the cards are stacked against us, and the chips are really down we do what we practice, we take matters into our own hands, we end suffering.

How do we get here? It’s a long road and many small steps, heart aches, and tears on the way  to Oz.

Being a veterinarian can be exhausting. You can get to the marrow tired. It can eat you from the inside out to the point of being all consuming. A gluttonous feast of your soul until there is nothing left to give and nowhere to seek salvation. A curse? Yes, it can be a curse. To care so much, to invest your whole heart, which is what many of our clients want for us as we care for their family members, and then there are the clients who ask you to remove a pet that they see as a burden. To juggle these emotions, these responses, and these ends of the emotional spectrum make it hard to navigate through each day.

We are all provided preservation mechanisms to protect our most precious inner self. Your choices are yours. Mask the difficulty of dealing with the stress with drugs, alcohol, and addiction, withdraw and leave the profession, start caring less, investing less of yourself, or burn out. Veterinarians are determined, driven, type A people. We as a species hate to give up, we loathe defeat, and we give until the bank is empty. Wear your heart on your sleeve long enough and someone will take it. But like every other thing in the universe with enough wear and tear on the system it will break down.

Four years at a school learning about the biggest, heaviest, and bulkiest transport vehicles in the world, steel ships, and I know that one big wave, one scrape on the bottom, or a swipe from an iceberg and that tin can will crumble, crack and sink. Nothing is impenetrable or unbreakable. Ask the Titanic or the Costa Concordia.

Did I learn about burn out, or compassion fatigue in vet school? No, you learn it in the field with those tiny sacrifices, those tiny blows, and those moments between the lines. You wake up one day and you realize that your life, your dream, and your reality are not one in the same. You dread work, you can't process the grief, the exhaustion, and the demands placed upon you.

Compassion fatigue is burnout when the candle that you are burning at both ends runs out of wax and wick. The profession can put unrealistic expectations on us. Our ability to maintain a level of empathy for every client, every incident and every patient is unrealistic. Our ability to wear every hat, mirror every clients expectations, and maintain a personal protective zone requires a strict code of rationing emotional handsels. 

Palmer

How does a normal rational empathetic person put a pet that they have watched grow from infancy to geriatric to sleep in one room and then walk ten feet away to another patient who you are expected to be jubilant and clear headed to examine, diagnose, and treat? Somewhere along the way we learn to mask, shelter, or disregard our emotions. Somewhere it became expected, and we learned to push feelings aside and press on. It is a recipe for a sychopath and a schizophrenic. And we do it every single day.

I will be the first to freely admit that I grapple every single day of my professional life with compassion fatigue. When you invest so much into one thing you expose yourself to being bankrupt should your house of cards fall. Can I tell myself that this is just a job, yes? Do I believe that being a vet is just performing a job? No.

How do I keep going? I pay attention. All the time.

I try to put myself first, I have to. I say no, a lot. I stay true to who I am. If you don’t care about your pet I am not the right vet for you. I stand by my core values.

I am also very honest. I tell my clients when I have just had to say goodbye to an old friend, and that I might need a moment to collect myself, refocus and devote the time and attention that I want to to their pet. I also invest my whole heart into what I do. I know that I cannot practice any other way. To do this I have to understand that there are clients that I am not right for. I can’t care more for their pet than they do, and I can’t be a compassionate vet any other way. I give termination letters to clients that do not share my perspective and I stand by my true clients come thick or thin, hell or high water.

And every day I remind myself how much I love to be a part of my client’s family, and how lucky I am to be living my dream.

Here is the advice from the professionals;  

1. Put yourself first. 
2. Stay an active student. Learn, grow, and challenge.
3. Exercise, eat well, take care of your temple. 
4. Be realistic with your expectations.
5. Attitude is everything, keep your chin up. 
6. Seek help if you feel overwhelmed.

Help, and seeking help, is something the doctors often feel embarrassed, ashamed, or beneath us to do. We are comfortable and expected to always be giving the medical advice and unable, unwilling, and mute to ask for it when it applies to ourselves.

Symptoms of compassion fatigue include excessive complaining, isolation, compulsive behaviors, poor sleep habits, poor hygiene, apathy, difficulty concentrating, chronic physical ailments, and withdrawal from friends, family, or prior interests.*

The next time you see your vet, tell them that you appreciate them, and remind them that you know that we are real people with real hearts. And for as many times as we vets tell our clients who say to us that they "will never get another pet because it's too hard to say goodbye when we lose them," the same goes for us. Don't lose your compassion in the trenches of our daily life. Remembering to love, care for, and maintain our empathy is what keeps us human.

*This blog was based on the facts presented at the 2009 CVC Baltimore lecture given by Renee Rucinsky, DVM, DABVP of the Cat Hospital of the Eastern Shore in Cordova MD.

I started Pawbly.com as a way to help more people with their pets care.  Every pet parent will tell you that the worst part of pet care is not knowing what to do, where to go, or who can help. I also know that the best place for help is with a vet, or their pet care professional.  I hope that it remains a community of support regardless of socio-economic status or access to accredited care. I know that giving back can replenish a tired soul. Helping people and pets can be fulfilling and there is great need. If you would like to join us in helping others please visit us on Pawbly.com. We are a free open community dedicated to sharing information to empower people who love their companions. 

I am also on Twitter @FreePetAdvice, on YouTube and at the clinic Jarrettsville Vet, in Jarrettsville Maryland.