Dan Gottlieb will talk about compassion fatigue with his guest Christine (see column below).

Dear Dr. Dan,

I've been facing a very painful realization about the impact my work is having on me. I counsel cancer patients both in person and online. I’ve been doing this for years and always felt so good from reassuring people about their diagnosis and care options since I had to go it alone when I had this cancer. But I feel like I’m getting burned out.

I’m discouraged that the therapies are not more effective and that sometimes I have this private knowledge that I know someone will die. I don’t know how oncologists do it.I also worry about being older and how much future I have left and whether I’m living enough for today. I have trouble sleeping at times too. I think about “my” patients a lot, especially one I’m working with who has a recurrence.

How do I distance myself from my work yet remain compassionate and caring? Christine I contacted Christine as I felt I could not do justice to her letter without knowing her a little better. I learned that 20 years ago when she was pregnant with her son, she was diagnosed with a very dangerous type of cancer that carried an unclear prognosis. She had little support from family or friends and felt very much on her own. Finally she found a wonderful oncologist who not only treated her but became a friend and mentor.

Shortly thereafter, she developed a helpline for patients to call and receive the kind of guidance and support she needed when she was diagnosed. She told me that over the years, she has felt deep compassion for the hundreds of people who have come to her with this disease whether they’re low risk, in the fight of their lives, or needing hospice care. 

When I asked her to describe what causes her the greatest pain, she said:“The losses weigh on me. Like when I ran across the email address of a patient I worked with who died.

I’ve started to think too much about the end of my life, that I could find myself with a recurrence. I am not great at living in the moment as I preach to patients.

I sometimes have a tough time coping with the usual anxiety in life, like when my son went to college last year.” 

Dear Christine,

What you are describing is technically called compassion fatigue, which is rampant in the healthcare field.

Compassion fatigue is more likely to happen to people like you who care deeply and want to do the best they can for everyone they see.  People with this condition often feel chronically tired, irritable and lack joy in their lives.

Many leave their jobs, or worse, protect themselves by not feeling compassion anymore. Sadly, we see the latter all too often in healthcare.  

The best way to begin dealing with this is to do what you have done — opening up about your sadness and confusion and asking for help. Sharing these emotions with kindred spirits is a good way to care for yourself.  

Like many who have experienced adversity, you have nurtured yourself by using your experience to help others. That's an essential way to survive trauma, but not so good if this is your only method. 

Compassion fatigue is about not having enough compassion for one's self. Patients often come to my office visibly distressed or exhausted. So before they start talking, I invite them to rest for a few minutes, catch their breath and find themselves. Often they begin to cry. I offered compassion that they desperately needed but didn't know it. 

Christine, please check in with yourself and do it often. Just know how you feel in any given moment and find compassion, even love for the person you are.

If you feel helpless, confused, sad, tired or frightened, let yourself have those emotions and care for the woman who is having them. If you can do that, you will have a better sense of what you need and will be more likely to give it to yourself.  

To me, the larger, most compelling issue is about life and death. Because of your experience and great compassion, I wonder if when a patient dies, you feel yourself looking at your future. And now the loss of your son and possible loss of your job may have you staring at that nightmare that began 20 years ago.

I invite you to sit still and make direct eye contact with your nightmare. What if you found out you didn't have much time to live?

What changes would you make?

Imagine this is your last summer and you will see the leaves change colors soon, perhaps for the last time.

Far from being a morbid experience, you might feel sad, but very alive.

Many years ago, I took a course in mindfulness meditation and a fellow student confided that she had stage three breast cancer and didn't expect to live much longer. I asked her why she would take a course like this at this stage, and I'll never forget her answer: “All my life, wherever I was, I was always somewhere else. In the time I have left, I want to be where I am and experience it fully.” 

Christine, I wish that for you and for the rest of us

Dear Dr. Dan Gottlieb,A few months ago I heard part of your show on the topic of caring and sympathetic doctors.  The part of the show I heard was unanimous that doctors should feel the pain of their patients. I can agree with that. A few years ago I walked out of the office of a doctor who was not very caring.  Doctors, funeral home directors, police officers, firemen, clergy, teachers, etc. and really all of us in helping professions can be more sympathetic. At the same time anyone who has a career in helping people, especially in their crisis times, has to be able to put away from the pain of others or that professional will not be able to survive emotionally for very long.  I am a pastor, and in one day I presided at the wedding of two very special people and two hours later I presided at the funeral of a beloved person. In the morning I felt joy with one family and in the afternoon I felt grief with another family. In the evening I had to disengage from both of those families and focus on my own family. To carry home the emotions, especially the grief, of earlier in the day would not be fair to my family.   Now speaking as an individual, I do have my special, unique pains that I feel and live through and I can’t expect every person to feel the pain to the same intensity that I do. I don’t want others to pretend.  

Dear Pastor,
thank you for writing this letter as I am going to deal with this subject in my column next week.  Many caregivers suffer with what is called compassion fatigue because those of us who care deeply often have difficulty establishing appropriate boundaries.I will later which will be the subject of my column

Dear Dr. Gottlieb:

What is wrong with me?  I really and truly understand that Mr. Vick had a horrible childhood.  A cruel childhood that led to unimaginable violence, dog fighting and G-d know what else.  I also understand the concept of paying ones debt to society and having a second chance.  But, after reading and trying to understand your column today-I still do not understand how he could kill a dog that did not win a fight in such a cruel and terrible way.  Couldn't he shoot the dog?  No!  He had to wet the dog and electrocute him.  Doesn't that say more about his heart than about his childhood?  What is wrong with me that I find his behavior more than just violent?  To me the man is innately evil.

I read about serial killers, arsonists, etc.  They invariably have been cruel to animals before they started their careers in violence toward humanity.  They are usually abused and cruelly treated themselves.  But, regardless of the reasons, they are evil.  Aren't they?

OK, lets forgive Mr. Vick.  Lets give him another chance to play ball, to talk to kids about violence and to try to help animals.   But, I would not leave him alone with those kids or with animals for any length of time.  Would you?  Or, is it just me?  Do I just not get it?

Brenda

Forgiveness is letting go of resentment, it's just that simple and that difficult.  Forgiveness has nothing to do with the other person, it has to do with the toxic anger we carry inside.  One could argue that they have good reason to hate, but it is the hatred itself that causes suffering.  What this man did was horrific and like I said, he might not be capable of change.  But the longer one carries their anger at him, the longer they suffer.  He does not

Can we rid ourselves of anger, like that felt by some toward Michael Vick?

Dan will be joined by for today's chat, starting at noon, by Dr. Ervin Staub professor of psychology at UMass and founder of the Psychology of Peace and the Prevention of Violence program there.

So just when I am thinking "enough with Michael Vick already, everyone has already said everything that can be said way too many times", I receive the following e-mail: 

Dear Dan,  I spent thirteen years working for the Federal Prison Service in various administrative positions from maximum to minimum security. I do not excuse what he did, but he did eighteen months at a maximum security prison in Leavenworth, Kansas with bank robbers, drug dealers, and people serving time for very serious federal crimes.  He was probably in barracks of four hundred other inmates, told when and what to eat, where to work (yes, everyone has a job) for pennies a day, when to wake up and go to sleep. And maybe the worst part of it all is the great shame of having your loved ones having to travel to prison only to see you in these circumstances.  It's all so very humbling, as it should be.  Its part of the price one pays for committing such a terrible crime.
Dan, he was twenty-seven; does he pay for this for the rest of his life?
People do change; I have seen many people living under these very isolating and humbling experiences wake up and realize what they have done.  And then I have watched them return to a community only to meet scorn and rejection.Why are we so vengeful?  Can't we rid ourselves of this anger just for a little while to see if this works? 
Peter 

Dear Peter 

Rid ourselves of anger?  Sounds great, but it doesn't come very easily, if at all.  Anger has been called a judicial emotion -- a reaction to injustice.    People who are divorced are often angry because of the sense of injustice as are people who have been traumatized in some way.  People can become angry as a result of social injustice like poverty or political oppression. Our angry reaction to injustice helps protect us from feeling the deeper wound of loss and helplessness.  Some use the anger to reinforce a sense of victimization, resentment or self-pity.  But others are able to use a wider lens and use the anger to pursue a social justice
.   What Michael Vick did to those dogs sparked a kind of outrage because of the horrific injustice perpetrated on those innocent animals.  In a way, the outrage is about a very human instinct to protect the vulnerable.But as we all know there is a very dark side to all of this outrage, and you touched on it when you used the word vengeful. Revenge and justice are two very different things.  Justice is about righting wrongs, revenge is about inflicting pain.

The important question is not about Michael Vick and what he deserves or doesn't deserve, it's not even about whether he is sincere in his stated desire to do the right thing.  The important question is not about him at all, it is about us.

 Peter, what you have attempted to do in your letter is to help us understand Michael Vick's experience in prison in hopes that understanding may lead to compassion.  Several years ago I wrote a column about four words that I felt could change the world. I felt, and still feel that these four words could cut down on divorce, help heal the wounds of trauma, and even help diminish international conflict.  Those words are: Tell Me Your Story.  Look someone in the eye and say those four words and just be quiet and listen until the other person is done.  That alone could change both of you. Just imagine how it would feel if someone who didn't fully understand you uttered those words.  But a little more is required for mutual change to take place.  When we listen to that story, we must do so with an open heart and simply imagine that story is ours.
 My daughter is an animal rights activist and has been most of her life.  She doesn't believe in killing any animals for any reason, she is vegan and does not wear leather.  So you can imagine how angry she is that Michael Vick was signed by the Eagles.  She was even angry at me when I said "let's see." 
I wonder what would happen if someone like Ali and someone like Michael Vick could sit across from each other and exchange those four words.  I don't know about his history with animals, but Ali might hear about how he was one of four children born to unwed teenage parents in a very violent drug infested housing project in Virginia.  That he did whatever he could as a child to escape the violence.  Perhaps she would hear more about how he experiences himself and his life back then, and in his heyday three years ago -- and now.  And what would happen if Michael heard than the Ali grew up with a mother who had cancer and a father who became a quadriplegic and was hospitalized for a year.  That her only real solace from her losses was with animals that she was able to love and loved her back seemingly without risk.  That she has devoted her life to caring for these critters and trying to make their world safer.  Perhaps she could tell him what animals mean to her.  And perhaps he would understand.  And perhaps then she would.And if we could eavesdrop on that dialog, perhaps then we would understand.

Of course I understand that his internal barometer of right and wrong might be damaged beyond repair.  Ali might look in his eyes and see that nobody's home as he tells a story he really doesn't believe.  His heart and his mind might be closed permanently.  But does that mean ours has to be?  After all, outrage and righteous indignation closes our hearts.

Maybe he is hopeless.  But then again...

This chat will be about marriage, how to heal what's broken and when to know it's time to end. Dan's guest will be psychologist B. Janet Hibbs, author of "Try to See It My Way: Being Fair in Love and Marriage."

A friend of mine was in an abusive (physically and verbally) marriage. AFTER the husband suffered brain injury in an accident, she discovered there was infidelity and other lies. The husband can no longer hurt her due to his injuries, he also does not remember the past. She is considering divorce. What would you tell her?

Your response will be greatly appreciated.

Thanks,

obviously I would need much more information and I would need it from this woman in order to explore what is best for her physically, psychologically, ethically and spiritually. So without that all I can say is what Hippocrates said: "first do no harm". So if she does leave him, make sure he receives the care he needs. And in order for her to be more comfortable inside of her skin, she needs to find compassion for both this man and herself. Both are victims and both have experienced their lives as being out of control. Granted, one did unconscionable things with those emotions that got out of control, but now she is at least safe enough to experience some modicum of care.

And this gets down to the simple fact that there are no rights and wrongs here, just decisions and consequences. If she stays, she is at risk for compromising her life in order to take care of a man who has harmed her. If she leaves, she might feel great guilt for the rest of her life. So if she stays, I hope she does so from a position of conscious choice. And if she leaves, I hope she does everything in her power to make his life comfortable so as to diminish that potential guilt.