CDN Health Professionals' Experience of Compassion Fatigue ...

I hated getting up in the morning to come to work, feeling that I couldn't do anything. I became cynical and satirical. I found myself being rude and sarcastic to my colleagues ... Whenever I would hear somebody else saying, "I'm so busy, and I am having such a hard day", I would try to be sympathetic but I had no sympathy for them. I was thinking, "You're having a hard day? I'm having a hard year."  Every day for me was like the one day that other person was having. I felt like saying, "Suck it up." That's not a nice way to be in a team ... but that's the way I felt.  

(p 125)

Above is a health care professional's comment that I read to a diverse group gathered for last Friday's Caring On Empty workshop. It came from the new Canadian book, Lying Down in the Ever-Falling Snow: Canadian Health Professionals' Experience of Compassion Fatigue, by Wendy Austin and colleagues. (2013)

This book is a multidisciplinary attempt to describe the phenomenology or felt experience of compassion fatigue and, in this regard, the authors have more than reached their goal. Listening with exquisite attunement, they have chosen quotations from healthcare professionals that describe the subjective experience of compassion fatigue with both subtlety and clarity:

One morning I was going in to work and I found myself in the midst of a ... full-on anxiety attack ... I just told my husband, "You need to turn around; I can't go to work today. That's it, I'm done. And ... I turned around and went home and called the doctor ... I didn't quit. I went on a leave.

One lady I had as a patient, she was newly diagnosed with diabetes and I was teaching her how to draw up her insulin with syringes and whatnot. I wasn't very patient with her. But I was just so exhausted and had nothing left to give. She made a comment to another nurse, and that nurse came up to me and said,"You know, your behaviour ..."  It made me realize that something was going on here. I'm not behaving the way I would like to behave. I'm not acting in a way that I would consider professional.

I feel like I'm just a bit of a zombie, no energy for anything. And it's not a physical tiredness; it is a mental tiredness, but it is also an emotional one and I feel just numb ... I really disconnect from my emotions and my body ... It's a dizziness in your brain, trying to find a way to take control of what is going on ... it's numbness and deadness inside. (It's) disconnection from people, disconnection from spirituality.

I couldn't get past my own suffering ... It was the first time in doing this kind of work that I felt like somebody needs to help me: I can't do it on my own anymore.

This attention to detail continues with the development of a uniquely Canadian metaphor for compassion fatigue. The suffering of patients and clients, seen as "ever-falling snow", is said to demand training and resources as we journey through the "winter country" of our work. We are exhorted not to give up in the face of that suffering or to "lie down in the snow" in our depletion, but to grasp hold of the knowledge, moral values and compassionate support within and around us so we can continue to journey onward.

Where I have had trouble with the content of this book, is in the lack of clarity regarding trauma as the central organizing principle of compassion fatigue. After two personal journeys through full blown compassion fatigue and six years of creating and facilitating CF workshops and master classes, I have come to believe that CF is primarily a trauma issue and that should we lose sight of that fact, we lose sight of necessary pathways to healing.

While I value the authors' thoughtfulness in teasing out individual contributory factors to CF, I see many of these factors as primary and secondary signs of posttraumatic stress, supporting the notion that trauma is at the core of CF. It is this larger picture of trauma that fails to come across in the writing.

I suggest that any of you who are interested in our evolving understanding of CF find copies of this fairly densely and academically written book and see what you think for yourselves. I would love to hear your comments.