Compassion fatigue

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