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Compassion Fatigue

Posted on September 9, 2019 | No Comments on Compassion Fatigue

It is an affliction rapidly and rabidly growing in number each day. A virulent and infective pathology silently spreading among the populace, gnawing their system little by little and slowly but steadily, attacking the core of their existence: humanity.

Though it is yet to be documented in medical annals and yet to be taught by professors in medical schools, it is an unrecognized health hazard, a gripping epidemiologic reality that could be costlier than any disease known today.

It is called compassion fatigue.

I first heard the term in an email sent by a former classmate when I was about to enter medical school. Apparently, the term was coined and used by a renowned physician who spoke before a graduating class in one of the country’s top medical schools. The exact definition or context it had been used I could vaguely recall at present, but the existence of which had caught my consciousness and had remained unchanged since then.

At that time, though, I had yet to prove its existence. The scientist and philosopher in me who valued reason above most things wanted to be convinced further. Like so many things unseen yet oft foretold, I must first experience something before I was ready to believe it existed.

Many questions racked my mind. Is it really possible to run out of compassion? Isn’t it that compassion is sprung from man’s thoughts, formed by his actions, reinforced by his habits, and thus becomes part of his character? As such, I thought it could not easily dissipate and saturate that rapidly. A scarier thought is, is compassion fatigue inevitable and incurable? Is it like a latent virus that is clinically asymptomatic at first but becomes a full-blown case when the host becomes susceptible or immunologically compromised?

My idea of the physician I wanted to be three years ago was clear and real in my mind. He must possess the following: a mind receptive to growth and change, sharpened by self-discipline; gentle, dexterous hands calloused and wrinkled from their continual use; and most importantly, a heart that is humble and compassionate, big enough to love even the most destitute and seediest of his patients, borne of God’s redeeming grace.

I was truly determined to be this doctor despite hearing occasional “real-life” horrific hospital stories during lectures by our doctor-professors and casual talks with clerks, interns and residents that tended to dampen the fires of idealism and passion I had. But I was an ardent believer of setting your own standards and making your own mark despite the countless others who harbored the same thoughts I have but who had been disillusioned along the way.

During our fourth and final year of medical school, our real medical education began. We spent an entire year as medical clerks in a government hospital in Manila, where we would be learning the ropes from more experienced colleagues in the medical field and where we could apply the knowledge that we have extracted from medical books to actual, breathing patients afflicted with real infirmities. It was Osler, I believe, who said that medicine is learned at bedside—not in the classroom. I couldn’t agree more.

It was during my clerkship where I really learned and understood the pathology that has been the object of my ruminations, that is, compassion fatigue.

Here is one scenario: A thirty-something male is brought to the emergency room, complaining of loose bowel movement and fever for three days. The emergency room is jam-packed with patients, not an uncommon sight in government hospitals these days due to economic difficulties, with only one resident-in-training, one intern and two clerks on duty. Patients are even encouraged to transfer to other hospitals or”transfer to hospital-of-choice” (THOC) in medical parlance.

The resident-on-duty immediately diagnoses his case as acute gastroenteritis and perfunctorily prescribes an oral rehydrating solution to replace lost water and electrolytes. He is sent home and advised for follow-up after one week. Unfortunately for the patient, due to sheer exhaustion perhaps or simple negligence on the part of the resident-on-duty, the latter fails to elicit a thorough history and physical examination and thus fails to correctly diagnose a more life-threatening co-morbidity being masked by his initial impression.

The intern-on-duty, having had a bad day herself, loudly reprimands the patient for staying longer than necessary in the emergency room. Although the patient’s relatives remain unconvinced, they have no other choice but to bring the patient home where the prescribed management can be continued. After a few days, though, some of the patient’s immediate relatives angrily march to the hospital and informed the resident-on-duty at that time that the patient died the day after he was brought home.

Just like that, just like a leaf tossed and carried by a gust of wind, his life vanishes into oblivion. I ascribe it to compassion fatigue.

Another case of compassion fatigue rampant in government hospitals nowadays: A full-term pregnant woman who has had regular, increasing “crampy”pain in the pelvic area and vaginal bleeding hours prior to consultation is rushed to the Department of OB-Gyn emergency room.The single resident-on-duty at the emergency room conducts her usual internal examination and finds out that the patient’s cervix is not yet fully-dilated, which simply means that the size of the mother’s birth passages is still too small in relation to the baby’s head, although the cervix is already one to two inches away from its full dilatation. So what the resident does is to advise the patient to go home, take a leisurely walk and come back an hour after, even though the emergency room is almost empty. Ideally, the patient should be placed in a bed or a stretcher in the emergency room so she could relax and be primed for the impending delivery of her baby. Labor, after all, isn’t termed labor for nothing.

I have witnessed a lot of residents resort to this behavior, this practice, although I still cannot understand their logic. One time, I was bold enough to ask one of the residents why she had refused letting a patient stay in the emergency room when in fact there was a lot of space to spare. The patient was definitely in labor, definitely in pain. The resident answered, to my deep consternation, that she would get really cranky when there would be lots of patients in the E.R. She even added that she has a hard time sleeping when there are patients writhing in pain at the E.R. I shook my head in my mind and muttered. Compassion fatigue, no doubt.

In every case, the manifestations are similar. It usually becomes symptomatic after a physician spends a long day in the hospital, usually when he is”from-duty” or in the case of those with impossibly low tolerance, when he is on-duty. On a more chronic level, a physician, after having been exposed to a lot of patients in the ward, after seeing the same diseases over and over for years, becomes acclimatized to his patients’ predicaments, almost expecting the same display of emotions in response to their diseases.

At its worst, compassion fatigue can be ascribed to a feeling of restlessness and hopelessness, that physicians can only do as much for their patients, that their powers in alleviating sickness is very much limited, that resources are insufficient, that medicine operates on a trial-and-error principle anyway, so patients should just resign their fates.

The same tone of voice is used all the time. Anyone can almost hear the impatience behind the words uttered or silent sighs unheaved behind the calm decorum. Anyone can sense that the physician seems almost uninterested in the patient’s plight and just wanted to get the patient out of the hospital the soonest time possible, regardless.

Although it is totally understandable and humane that physical exhaustion can sometimes cause one to act out of character or abandon one’s ideals, it is utterly unthinkable in this vocation to allow compassion and kindness to be chiselled away when these two building blocks form the core of a real healer. Without compassion, every patient is reduced to a disease to be managed, a problem to be solved, a lesson to be learned, an experience to be undertaken and even worse, a meal ticket or a financial resource.

Medicine is truly not for the faint-hearted. I have come to realize why it is called a “calling.”The impediments along the training can really be disheartening, disquieting even. The physical and emotional battery can really test the most solid and formidable of characters. The sacrifices that one has to make seem endless and very much pointless, especially in today’s pragmatic view of medicine: the avalanche of nurse-doctors and “commercialized”doctors.

Sometimes, a doctor is faced with the grim realities of humanity, physical suffering, emotional trauma and spiritual emptiness, such that he too becomes drained, bereft of the essential qualities that make him a healer. I have come to answer my own questions. Compassion fatigue is inevitable. Reality check: every doctor has most probably become afflicted with it at some point in his practice. Fortunately, though, it is not incurable.

Like many diseases recognized today, there is always hope. The physician must take time, though, to diagnose it in himself and to actively, consciously take steps to combat compassion fatigue and to eliminate it from his system to avoid future recurrence. Taking the time to rest, to meditate and to ask help from God provide the guaranteed cure, even if this isn’t evidence-based medicine.

After all, there is a compassion that never tires, never fails when ours does. And it only comes from the Great Healer Himself, our God who is benevolent, compassionate and faithful at all times. We should all turn to Him if we want our weary hearts and minds to regain their strength and zeal.

One need not obtain a medical degree to realize this.

By Elvie Victonette Razon-Gonzalez, MD

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