Saturday, January 10, 2009

on compassion and fatigue

at the risk of my readers thinking i am terrible person and veterinarian, i am going to post the following anyway. this is the very definition of compassion fatigue. a caveat: i am not a horrible person, and i would never deliberately hurt an animal. the day i do is the day i quit being a vet.

last night, i felt like there was a hole in my soul. all week, there have been 2 themes: no money and euthanasia. granted, i work in emergency medicine. some weeks aren't like that, though. some weeks - in a whole 7 day span, i'll do 5 euthanasias or so. on thursday night, i did 4 in a row. i examined and sent home animals with major medical problems because the owners had no financial resources and didn't qualify for care credit.

last night, i was angry and my temper was short. i felt terrible. i actually felt angry toward animals - which has never happened to me before. normally, i just feel bad for them - even the biters, scratchers, growlers, and thrashers. after all, they're animals - it's not their fault. i don't tolerate rough handling or saying bad things about patients. it's not acceptable - ever. last night, i almost lost my temper with a terrified patient. i made myself stop handling the dog, take deep breaths, and had a technician take over, while i stepped outside to compose my shaking, barely holding it together self.

i also had a couple who brought in a cat that was mauled by a dog. there were 2 crush wounds on either side of the body - one penetrating the abdomen, one penetrating the thorax. a hernia or massive hematoma was visible on the side with the abdominal hernia. the cat needed shock stabilization and emergency exploratory surgery. the owners didn't really have the funds of $1500 to spend on this cat, although they wanted to and could have done it, had i pushed them. but they really wanted to take the cat home and at least "give it a chance." i explained to them that the cat would likely suffer a slow, horrible death if they opted to do that. i dealt with them as compassionately as i could, but i'll be honest - in my head, all i could think was "hurry up and make the damned decision to put this cat down!"

that's a terrible feeling to have. as i euthanized the cat, i didn't feel a drop of sadness. i just felt empty. even when the owner gathered the cat in his arms and sobbed. normally that - at the very least - prompts a few tears.

i asked my boss/senior clinician (after the evening rush was over around 1am) if i could go home and recuperate before the weekend. on saturdays and sundays, i don't have to be in for the night shift until 8pm. so i came home and attempted to relax.

this morning, i woke up at 8:15am after dreaming all night of dying animals and sobbing owners.

all i can say at this point is THANK GOD that i'm going to NAVC (north atlantic veterinary conference) in orlando in 1 week and will have a whole 7 days away from my job.

now if only i could afford a shrink!


Anonymous said...

I'm not a vet, but here's what I think about it:

If you care personally about every patient, how can you do your job? It's like what they say about surgeons not being able to operate on their own children.

You're under incredible emotional stress because you probably care too much right now as a new doctor, and it's obviously taking its toll. I think this is the other end of the pendulum's swing, and you'll reach the balance in time.

I would have lost my calm much sooner trying to deal with aggressive animals, even if it is because they're scared.

You've said this is something all vets need to guard against, but that means all vets struggle with it. I think you shouldn't feel so bad about feeling so bad.


Anonymous said...

Feeling so bad about not feeling much, rather.


all but 1 said...

Babe, you gotta step back and grow some armor around your heart before you burn out before the internship is over. I know when I'm letting too much in by how close I come to crying during a euthanasia. Of course I'm not you, and you're not me, so just do whatever you need to do to get a break. Enjoy your time in Florida - I wish I had access to a CE conference this year.