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Jerome Stone

Is There Such a Thing as Compassion Fatigue in Healthcare?

Compassion fatigue? It's an Interesting phrase, one that's used daily when describing what healthcare practitioners encounter when they burnout or experience loss of empathy while caring for others. And even though it's used a lot, I'm not sure that it really makes sense.

Just for the heck of it, I did a Google® search for the keywords "compassion fatigue in nurses" and came up with 110,000 links...110,000! Oh my gosh, you’d think that we’re all suffering from burnout, which can’t be possible…or, is it?!
I know that in my nursing career, there have been times when I've been there, when I've just cared for someone who really needed my heart and mind at the bedside and I've walked out of their room saying to myself, “Why the hell am I still here?!” At those times, I've had to ask myself where my heart and mind have been and why has it been hard to show up at the bedside with them intact.

What is compassion?

In 1950, the eminent and well-known physicist, humanitarian and philosopher Albert Einstein wrote:

A human being is a part of the whole called by us “Universe,” a part limited in time and space. He experiences himself, his thoughts, his feelings, as something separate from the rest—a kind of optical delusion of his consciousness. The delusion is a kind of prison for us, restricting us to our personal desires and to affection for a few persons nearest to us. Our task must be to free ourselves from this prison by widening our circle of compassion to embrace all living creatures and the whole of nature in its beauty. Nobody’s able to achieve this completely, but striving for such achievement is in itself a part of the liberation and a foundation for inner security. (1)

So, according the Einstein, compassion is an embrace of "...all living creatures and the whole of nature in its beauty." How then could we become fatigued from such an embrace?

And, in The Tibetan Book of Living and Dying, Sogyal Rinpoche writes that compassion, "...is not simply a sense of sympathy or caring for the person suffering, not simply a warmth of heart toward the person before you, or a sharp clarity of recognition of their needs and pain, it is also a sustained and practical determination to do whatever is possible and necessary to help alleviate their suffering."(2)

So, perhaps it's the "...sustained and practical determination..." that causes people to become fatigued. But what is that determination "...to do whatever is possible..." and can it really fatigue us? Or, is it a matter of not caring for ourselves, or not realizing that within each of us there is a wellspring of compassion, unlimited by the duration that we serve others, or by the amount of suffering that we witness. Have we lost the connection to that part of ourselves that can heal as Mother Theresa healed, to care as Gandhi cared, to give as selflessly as those we admire have done?

Why do we burnout? Why do we experience fatigue when we're caring for others? Why do we feel that to be compassionate has to take its toll, rather than lift us up? Is there something that I'm missing when I feel burned out after caring for another, something that I'm doing, or some way that I'm being that is preventing me from feeling uplifted by what I'm doing?

There's actually plenty of evidence that shows that not only does caring for others not cause fatigue, but quite to the contrary, that helping others can actually make us happier. And research into practitioners who use compassion meditation techniques has shown that we can actually modify the neural (brain) pathways that control our emotions in a way that positively affects how we perceive others.

In thinking about how it is that I keep my heart and mind intact at the bedside, and what it is that helps me to bring them back to my caring when I've checked out, I've come up with a list of five components of a compassionate and contemplative practice that are powerful antidotes to the fatigue that I feel when caring for others. Here they are:

  1. Remember to give ourselves the same love (or care if that’s an easier word to work with) that we want to give to our patients. Don’t we deserve that much care? Where have we gone wrong where we’ve equated selfishness at the expense of others for a genuine love for ourselves, compassion for ourselves? Why do we believe that caring for ourselves is any less important than caring for our patients?
  2. Recognize others, those who we care for and those around us, as wanting the very same things that we want, to be happy and to be free from suffering. This can be essentialized when we say, see others as being “another me.” When we think about it, those we care for are like us in their desire to be free from suffering and wanting to be happy.
  3. We need to remember, repeatedly, that whatever we’re feeling at the moment will eventually dissipate, and that we’ll be feeling something different within a matter of minutes, days, or even weeks. That is, everything that we experience and feel is impermanent, so if we can remain present in the moment while we’re attending to another, without letting the thoughts and feelings of the moment distract us, we can mind the bedside more easily.
  4. We need to remember our connection with others. Like Einstein’s quote, “[we] experience… [ourselves], [our] thoughts, [our] feelings, as something separate from the rest—a kind of optical delusion of [our] consciousness. The delusion is a kind of prison for us, restricting us to our personal desires and to affection for a few persons nearest to us.
  5. Finally, and I stumble on this one constantly, is to forgive ourselves each time that we find ourselves standing knee-deep in mindlessness. Each time that we remember that we’ve forgotten to be present is an invitation to return to our mind and to our intention to care.

These five components, self-love, seeing others as another me, the temporary nature of feelings, our connection to others, and forgiveness as the "secret sauce" of being with others and showing up in a way that doesn't deplete us. Instead, they renew us, reviving our connections to others and reminding us of our inherent goodness.

In addition to using these five "techniques" of a contemplative practice, there's one practice, you could call a “meditative” practice, called loving kindness that helps us to work with these points. In a post on this site, titled, Metta or Loving Kindness, Sharon Salzberg briefly discusses metta, or loving kindness, "...knowing deep in our bones that our life is inextricably interwoven with all life, and that because of that we need to take care of one another -- not out of sloppy sentimentality or pretentiousness, but out of wisdom." You can also watch a video in which Sharon explains loving kindness here:

 

Sharon Salzberg on Loving Kindness from WhatMeditationReallyIs on Vimeo.

Something that I do to remember compassion and to keep within my mind a sense of ease in practicing it is this Loving Kindness Practice. I wrote it for people who visit by blog and find that it's handy because you can carry it in your pocket and read from it during your breaks at work, or use it at home. 

What exercises like loving practice, and points like the five that I've presented here, and hundreds of other resources that are available to us do is to remind us that compassion is a state of mind and a state of being. And when we are being compassionate, there's nothing about that state or presence that's fatiguing. Far from it! In fact, I find that when I'm really in my heart or practicing nursing from the heart of my awakened mind, I feel alive, well and energized...even when I'm exhausted! What's actually fatiguing isn't compassion but the exact opposite, holding on to my claustrophobic sense of self. Compassion, embracing "...all living creatures and the whole of nature in its beauty" releases that claustrophobic grip!

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(1) Letter of 1950, as quoted in the New York Times (29 March 1972) and the New York Post (28 November 1972). However, The New Quotable Einstein by Alice Calaprice (Princeton University Press, 2005: ISBN 0691120749), p. 206, has a different and presumably more accurate version of this letter, which she dates to February 12, 1950, and describes as "a letter to a distraught father who had lost his young son and had asked Einstein for some comforting words." A human being is a part of the whole, called by us "Universe," a part limited in time and space. He experiences himself, his thoughts and feelings as something separate from the rest—a kind of optical delusion of his consciousness. The striving to free oneself from this delusion is the one issue of true religion. Not to nourish it but to try to overcome it is the way to reach the attainable measure of piece of mind.

(2) Rinpoche, Sogyal. The Tibetan Book of Living and Dying. San Francisco:HarperCollins. 2002. Pg. 191.