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When caring becomes too much: My experience with compassion fatigue

INSTAGRAM @mirandaacvsdvm   
Miranda Cisneros obtained a bachelor's degree in criminal justice in 2016 and graduated in May 2019 with her doctorate in veterinary medicine. She has a passion for orthopedic and soft tissue procedures and now, is a surgical resident at an emergency animal hospital in Virginia. Follow her on Instagram to learn more about her residency journey.

While working in veterinary medicine can be rewarding, there are many stressors that have the potential to put those who work in the field at an increased risk for developing depression, anxiety, and suicidal thoughts.

One of those stressors, compassion fatigue, can come while providing moral support to clients. Compassion fatigue tends to happen when an individual is exposed to traumatic situations repeatedly and feels them second-hand, which can ultimately drive them to depletion. Crocker and Nerdia, 2016 article mentioned that, signs of compassion fatigue are difficulty concentrating, sadness and apathy, nightmares, and lack of self-care (hygiene).

Often, clients who come into the emergency room (ER) don’t have the mental preparedness to receive their pet’s diagnosis or the financial means to accept the recommended treatment. In specialty practices, it is not uncommon to have to go over finances with an owner, give the best treatment option and be left with the question, “Is this the best diagnostic route to go with?” One of the most difficult responsibilities that veterinarians are tasked with is to provide counsel to pet owners on the decision of end-of-life care. Informing the pet owner about their options to potentially euthanize or medically manage their pet at the end of its life can be taxing. A lot of times, veterinarians are put in situations where they have a very clear direction of what they feel is necessary, particularly in regards to potential prognosis and finances. They must then inform the client, which can cause significant stress due to the unpredictability.

For example, I had a client come into the emergency clinic I work at for a consult for a partial liver removal following ultrasound results that showed hepatocellular carcinoma. The client, who was already distraught over the recent passing of a close family member, had told me that they were going to kill themselves if their dog died. The client was fully aware that the consult could reveal a positive outcome with high success or potential complications. Having to handle such a difficult situation, I did my best to keep the client calm by reassuring them that their pet needs them. At the end of the consultation, the client informed me that if I had not heard from them in the next few months, they would have ended their life. While this is an extreme example (and the first of this sort that I’ve experienced as a new veterinarian), it highlights the emotional toll veterinary professionals bear.

Beck in her 2018 article mentions, a certain level of emotional labor is required to perform in this field; most typically when a client becomes extremely distressed or aggressive, following the diagnosis of a pet. Emotional labor, a term coined by Arlie Hochschild in his book The Managed Heart, describes the act of managing emotions in order to meet the expectations of a job. To use my first example, even though I was distressed by the client’s comments, I could not show it. Instead, I had to remain professional in order to calm them down. Additionally, not knowing how to properly handle such a situation was mentally taxing. I, nor my team members, are trained mental health professionals, and calling for help could further distress the client. The protocol for a situation like this required me to sit down with my superior and discuss the situation and from there, follow up with the owner on my behalf to see if we can provide her any resources or be of assistance to her in her time of need. This was something my colleagues and I carried on our conscious. It is difficult to want to help and not knowing how to. In the end, all I could do was reassure them as best as I could regarding the health of their pet and its quality of life moving forward.

Another situation I’ve encountered was on New Year’s Eve—a night that proved to be unusually busy for the hospital. Of course, working in emergency that’s bound to happen right? Sure, but on this day, it just seemed like we were the only ones open. I was on ICU rotation and around 10 a.m. the influx of patients was just rolling in and about half of them had been admitted. When I heard an ICU doctor yelling, “If you see a cage open, stick the pet in there,” I started to become overwhelmed. Behind one closed door, I was dealing with a client who gave their epileptic dog a double dose of phenobarbital because their pet had three cluster seizures in less than an hour and had to go into immediate thinking mode to provide a life-saving diagnostic plan that would resolve the fatal issue quickly. By the end of my shift, I saw more than 20 patients. Having to write medical reports for every one of them became difficult because I was starting to mix them up. Ever since that day, I had nightmares about the cases I dealt with and wondered if I did the right thing. This experience allowed me to grow as a veterinarian because it made me realize that I can only do the best I possibly can in any case that deal with, I won’t have all the answers, but allow myself to adapt to situations that are most times, out of my comfort zone.

Something that can also follow compassion fatigue is burnout. Burnout is a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress. Signs can be disengagement, anxiety, and fatigue. It occurs when you feel overwhelmed, emotionally drained, and unable to meet constant demands. I experienced this when I worked in general practice (GP) for three years. The workload (having to last for eight to fourteen hour shifts almost seven days a week) on top of working with various clients and having to cooperate with them, tending to their everyday emotional needs regarding their pet(s), and playing therapist, was tiring. This caused me to get fatigued and eventually grow away from GP all together. The transition from GP to ER was a bit out of my comfort zone. While in GP I was mainly transferring ill patients to the ER for more inclusive care. Now, I switched from behind the scenes to in the action and having to take over cases from the night before and either continue treatments or discharge patients or having to give CPR like the drop of a hat. The learning curve for me is staying ahead of the game and juggling more clientele.

As a veterinary professional, remember this: we can only do so much. Talk about what is stressing you and grant yourself permission to acknowledge your stressors and relief in it. Work-life-balance and self-care are personal investments and should be encouraged. Remember to BREATHE. You got this.

References

Beck, Julie. The Concept Creep of ‘Emotional Labor’. The term has become a central part of an important conversation about the division of household work. But the sociologist who coined it says it’s being used incorrectly. The Atlantic. 26 Nov 2018.

Cocker, Fiona, and Nerida Joss. “Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review.” International journal of environmental research and public health vol. 13,6 618. 22 Jun. 2016, doi:10.3390/ijerph13060618

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