When compassion leads to fatigue…

There is a quote from a prominent veterinary oncology text taped above the computer monitor in my office stating: “True oncological emergencies are rare. Emergencies of emotion, however, are quite common.” I realize this expression may not resonate well with an owner of a pet with cancer, and could even be misconstrued in an offensive manner. Yet, I personally do not see vindictiveness in the words, and I certainly do not display them with any malicious intent. For me, they serve as a reminder of how important it is to “Keep calm and carry on” as they say. Truth is, I find it far too easy to become caught up with the circulating emotions of my day and allow them to influence my life at and outside of work, and to lose sight of how my chosen profession represents only one aspect of the person I am. Those two sentences help ground me when I otherwise feel helpless to the turmoil of the day.

 

Compassion fatigue is defined as a deep physical, emotional and spiritual exhaustion accompanied by acute emotional pain. It can also be described as an extreme state of tension experienced by individuals helping people in distress, including preoccupation with the suffering of those being helped to the degree it is traumatizing for the helper.  Typically, compassion fatigue is thought of as a condition pertaining to people working in the human medical field, but is now becoming more recognized in veterinary medicine.   I often wonder, how can it be discerned when the line is crossed between caring enough and caring too much?

 

Veterinary medicine, as a whole, is a profession not built on gratitude. Veterinarians do not garner the same respect and admiration as our human MD counterparts, yet our degree requires similar undergraduate and graduate school degrees. Veterinary specialists complete internships and residency programs of similar caliber to human doctors, while competing for far fewer positions in each category overall, and once completing those programs, compete for far fewer jobs. I also find some owners are quick to find fault with veterinarians for a misdiagnosis, or what they perceive as a poor recommendations or communication, or worse yet, claim vets are more interested in generating revenue than maintain the best interests of their pet. Although there are probably some truly dishonorable veterinarians out practicing medicine, having worked in several hospitals over the past few years, I can’t say I’ve met one myself.

 

Veterinary oncology is not a glamorous specialty by any means. In fact, on the worst of days, it can be downright draining. Obviously the good far outweighs the bad, or else none of us could continue on this path for our livelihood. But there are many times when an owners feelings trump rational thinking, and in an instant, I am forced to step out of my role as medical advisor and transform into a psychologist or grief counselor. From experience, I can say this is not something taught from a book or a lecture in vet school. It’s learned experience combined with basic emotional capabilities, as well as a little bit of luck at times.   We may be able to give ourselves to our owners and our patients, but I have to question to what expense are we doing so?

 

I think people associate veterinary oncology with negativity because of a perceived increased proportion of patient-related deaths, but death is actually a rare event on our service. And often, when it is time to say good-bye to one of our patients, though absolutely heartbreaking, it is something owners know is the right thing for their pets and the emotional toll for me is tempered by knowing humane euthanasia is the kindest option for that animal. I’m not saying it doesn’t hurt to lose a patient, because it does. But the pain related to relieving suffering from a cancer diagnosis stems mainly from the loss itself, and is mitigated by knowing what I am doing is exactly what I am trained to do: relieve suffering and pain.

 

What I personally find far more emotionally impacting is finding a way to console owners, distraught over a recent diagnosis of cancer, who are only able to feel the urgency imparted by the diagnosis itself.   We recognize the strain this causes and we will do everything we can to fit the pet right away because we know it is not only important to help the animal, but sometimes even more so, to help their owners cope with the diagnosis and to educate them about what would be the next recommended steps. We continually work and re-work our schedules to fit patients in on emergency bases. Truth be told, there are few cancers so aggressive where waiting a day or two to schedule an appointment would truly make a difference in the pets outcome. And for cases of extremely sick pets with cancer, there are often very limited options for what can be done to help them, so that when we do fit those patients in on a last-minute basis, I have nothing to offer.  True oncological emergencies are rare indeed. But we are patient and understanding to the feelings and needs of our clients, sometimes to the detriment of our own.

 

The same is true for owners of pets currently undergoing treatment for their cancers. A single episode of vomiting or diarrhea, or a missed meal that typically would go virtually unnoticed now evokes a sense of urgency. I know it can be difficult for owners to discern what would be considered severe side effects from treatment versus “normal” mild adverse signs in their pets and we make ourselves overly available to help with their questions and concerns. This means we are continuously busy with phone calls and emails from owners, including days where we are not in the office seeing appointments. We field inquiries as rapidly as we can in order to assuage fears and triage emotions to the best of our abilities, keeping in mind on days we are seeing appointments, we are simultaneously usually dealing with new and equally distraught owners as mentioned above.

 

My standard of care is a proverbially impossible double-edged sword: I want my owners to feel as though their pet is the only pet I am concerned with at all times, yet simultaneously I want them to somehow understand and be cognizant of the fact that I treat dozens of patients a week who matter just as much to me as their own pet does.  I can tell you from experience, it is virtually an impossible task to keep everyone happy all the time.

 

A diagnosis of cancer is emotionally provoking on so many different levels. It’s certainly easy to see how this is true for the pet owner, and as a veterinary oncologist, I know part of my role is to help people cope with their concerns and be an advocate for their animal throughout their treatment plans. I would hope with the information provided above, I could offer some insight into the feelings encountered by the medical caretakers of pets with cancer. It’s hard for us too, but we accept our responsibilities gratefully, even when it feels as though the appreciation for our role wears thin. The good days far outweigh the bad days, and the true emergencies are rare.

 

Please remember that we do care, often more than we are comfortable showing outwardly. It’s all a part of what makes us so good at what we do.

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