When you work in a busy ER, you see a lot. Lisa Moran* knew that when she took the job seven years ago, but she wanted to help people, describing it as her calling. When she started feeling as she says “a numbness,” she thought she might have to leave her job. She soon learned she was experiencing something few healthcare workers talk about: compassion fatigue.
“I had never heard of it before,” says the Mullica Hill resident, “but I attended an in-service and that was one of the topics. Everything they said described how I was feeling. I thought I was becoming this terrible person, but I wasn’t.”
Compassion fatigue describes what happens when someone who routinely provides care in stressful situations – a first-responder, a crisis or social worker, even a family caregiver – becomes emotionally exhausted and indifferent to the traumatic situation in front of them.
“Too many demands are placed on your feelings, so you are no longer able to feel sympathy for the misfortune of others,” says social worker Kim Rumaker of Samaritan Healthcare and Hospice. “You’re ability to empathize and see things from their perspective is lessened. You just don’t have the reserve to do it.”
Rumaker says she believes there have been times when she’s experienced compassion fatigue, although it was short-lived. “I’ve been in the field 10 years, and there have been times when I thought to myself, ‘Why didn’t I cry about that? Why don’t I feel sad?’ It isn’t that you no longer care, you just don’t feel compassion. You may hear the same sad story multiple times in one day, and when you get to the fourth person telling you the same story, you’re not able to be in that moment with them the way you really want to be.”
Often, the healthcare worker or caregiver doesn’t recognize what’s happening, and their fatigue worsens. Soon, they exhibit emotional and physical symptoms, like inability to sleep, loss of appetite and stomach problems.
“Eventually, your body says, ‘I can’t do this anymore,’” says Larry Gevirtz, who oversees crisis intervention services for Twin Oaks Community Services. Gevirtz says the worker will also feel out-of-control and often become depressed.
“It’s all about hopelessness,” he explains. “Think of nurses in emergency rooms. They see everything: gun shot wounds, rape, domestic violence. The things most people read about in the paper they see every night, again and again. Over time, your can change to ‘the world is full of people with guns shooting at each other for no reason. The world is full of rapists. The world is full of people who are going to kill and rape and rob.’ If you allow that perspective to be the only thing you see, well then, the normal human reaction is hopelessness. You have to find a way to protect yourself from the slings and arrows of the world but still find a way to be human.”
While it’s difficult for workers to recognize compassion fatigue in themselves, Rumaker says it’s up to colleagues to look out for each other. As manager of social work, spiritual support and the Center for Grief at Samaritan, Rumaker provides training to her staff on the signs of compassion fatigue. Gevirtz says that’s a big part of his job too.
“More often than not, you have to rely on your teammates,” he says. “It’s colleagues who will come over and say, ‘Why don’t you take a little break?’ And hopefully, if this individual is the right person for the job, they take a deep breath and say, ‘Oh my goodness, I didn’t even realize what I was doing.’
“Several years ago, I was trying to help someone and it was very clear they didn’t want any help,” continues Gevirtz. “I really got out of my rhythm. In my head, I was saying, ‘I’m going to help you!’ which goes against everything I believe in. One of my colleagues tapped me on the shoulder, took me aside and said, ‘Are you aware what you’re doing? I was like, ‘What are you talking about?’ ‘Well, you’re trying to give this person help, and they don’t want it.’ It was like ‘ka-boom!’ It was like one of those light-bulb moments. I just didn’t have the self-awareness at the moment. I apologized to the client and told him it was ok if he didn’t accept my help. And we had a normal conversation. My colleague had my back.”
Gevirtz says compassion fatigue covers a wide spectrum of behaviors, and his personal experience is a minor one. Someone whose compassion fatigue was more advanced would start isolating themselves, become rigid in their work, miss days at work and eventually find it difficult to function.
“Oddly enough,” adds Rumaker, “you might see a pattern of being over-involved with patients, because they are having difficulty separating work from their personal life. They are in such a mode of, ‘I don’t know what to do,’ they try to over-compensate. Boundaries become blurred.”
Sometimes the very reason a person chooses to become a first responder or crisis worker – the desire to make a difference in the world – is the reason they experience compassion fatigue. “Consider a policeman or a fireman,” says Cooper University Healthcare psychiatrist Consuela Cagande, MD, “They have an altruistic nature. They give up a lot to help people, they want to help, and sometimes when they respond to these situations, they can’t and they feel helpless. They set themselves up to feel helpless. And that helpless feeling then becomes hopelessness, and that leads to depression or even just feeling numb emotionally.”
Since 9/11, Cagande says, there has been a greater effort to monitor the mental health of first responders and crisis workers, and provide training to recognize and prevent problems like compassion fatigue. One of the best prevention tools, she says, is personal self-care.
“Self-care helps a lot,” she says. “You have to take a break, to get some sense of normalcy back. Read a favorite book, go back to your hobby. Refresh your brain and reboot, like you would with a computer.”
Cagande says that is why first-responders called into a catastrophic event, like a hurricane or forest fire, work in shifts. “You have to take a break,” she says.
Twin Oaks’ Gevirtz says he encourages his counselors to speak up when they need a break. “Sometimes you’ve got to say, ‘I need a day or two off from work. I need to go to a movie, hide under the bed, go bowling, whatever works.’ If work is the center of your universe, that’s no good. But if you can find quiet time for yourself, your body can heal.”
While therapy can also treat compassion fatigue, Cagande says self-care is often the only action needed. “Find anything you can do to bring you back to a positive normalcy,” she says. “Because if this is your profession, you’ll want to get back to work, so you need to be psychologically prepared for what will come next.”
