Irreverent. Flippant. Insolent. Uncivil. Uncouth. Crude. Rebellious. Defiant. Resistant. Unmanageable. Insubordinate. Alive.
Compassion fatigue can lead us down many paths. When we undertake the impossible task of helping people, we do what we can to survive the emotional roller coaster we have just willingly boarded. Because it is unprofessional to indulge our innate reactions to the terrible things we see every day, we use other tools to cope. We put on suits of armor that look like gallows humor, cynicism, rebelliousness, and apathy. What does your suit of armor look like?
Sometimes the suit of armor becomes too heavy to bear.
It starts to rust at the seams. It seizes up and we can no longer move. It gets really dark behind that mask. This is an irreverent blog for healthcare professionals who avoid self care like the plague, but compassion fatigue is no joke. I’m trying to get your attention. I’m speaking to that suit of armor you’re wearing. The one that laughs in the face of tragedy. And once I get your attention, I want to deliver a very serious message: this sh$+ is real and your life is at stake.
In an ideal world, you would have ample support for processing all the hard stuff you go through every day.
You would take care of yourself in all the right ways. Your employer would provide resources to make sure your mental health was fully in tact before you set foot in the workplace. You would have all the tools you need to do your job to the best of your ability. Your family would have endless energy to help you debrief at the end of each day. But this isn’t an ideal world. The only things you can really control are your own choices and sometimes those seem pretty grim.
I want to help you identify your limits before you reach them.
I want to help you make a plan so that if you do reach those limits, you will know exactly what to do. I want to make sure you don't get stuck in your rusty suit of armor.
Before we go further, I want to acknowledge that you may already have reached one of the two ultimate limits. If you are thinking of harming yourself or someone else, please call 911 or the National Suicide Prevention Lifeline at 1-800-273-8255. I sincerely hope you’re not in this place, but please know there is help out there. Don’t give up on yourself.
Okay, now it’s story time.
When I was in college, I took a class called The Psychology of Gifted Women. In that class, the professor had us complete an assignment called “The Life Dreams Project.” We were instructed to imagine our ideal life and then dig into the details of that life. We even made a budget. There was one caveat: we had to imagine that we were building this ideal life as a single parent raising two children. We had only our own source of income to pay for all the things we wanted. In my life dream, I was a clinical psychologist, I lived in a picture perfect bungalow in a city, and I had a pottery wheel in the basement. Plus the two kids, of course. Being a single parent didn’t bother me. I had no conception of the stress that would go with raising children. I was much more focused on the pottery wheel. I had this life dreams thing nailed down.
Shockingly, life didn’t go exactly as planned.
I decided clinical psychology was not for me. Instead, I went to law school. I lived in two medium-sized cities before I moved back to rural Montana. I don’t want to spend my life in traffic. Plus, I missed the mountains. I don’t have any children but my partner has two teenagers that I get to spend lots of time with (I even get to drive them to their after-school activities). I have never had a pottery wheel and I have not even used one since high school. I did live in a bungalow for a few years. It was very cute, but not quite as big as I had imagined. Over the years, I have adjusted my life dreams and have become better about being realistic while allowing myself to imagine the utopia.
In addition to the life dreams project, my professor had us identify our relationship non-negotiables.
She told us this exercise was best done while not in a relationship because current relationships skewed our perspective. Either we would nitpick the things we thought we were missing or we would minimize the things we really wanted if they weren’t there. Luckily, I was single. I don’t remember all the non-negotiables thought up by my 20-year-old self, but I do know my future partner would have to be smart, creative, a good listener, and, above all else, respectful of other people. Full disclosure: I still have a very optimistic imagination. This is a blessing and curse.
As I navigated the dating world in my twenties, I actually did refer back to this exercise.
Some of the pieces were much more straightforward than others. One time I went on a date with a guy who only asked me about bands I liked for the entire meal. Do you like Alice in Chains? Do you like Nirvana? Do you like Blink 182? Do you like Smashing Pumpkins? And on…and on…and on… Then I saw him a few days later and he asked me, in his stereotypical 80's movie football jock voice, “Hey, is your name Jamie?” He acted like it had been two years since our date. That guy did NOT check the intelligence box. The “respectful of others” criterion was a bit less obvious and took more time to assess. Most people seem nice at first. It takes time to find out a “nice” person can also be sexist, racist, or homophobic.
Both the Life Dreams and the Relationship Non-Negotiables exercises were helpful.
When I hit a crossroads or was feeling confused, I could refer to them to help sort through the spinning thoughts in my head. They were something solid I could hold onto. They were created when my mind was less muddled. They were more trustworthy than my current state of mind. They were like a wise friend when I couldn’t hear my actual wise friends. I had already outlined the things I wanted in life AND the things that I would not put up with. If I was struggling with what step to take next, these tools were there to help me make the tough decisions.
You can do this for your career in healthcare.
Here are a few things you can ask yourself. Think about them for a bit and then write them down. If you don’t take the time to write them down, you will not be able to hold onto them when you are spinning out of control. Grab a piece of paper and just start writing. You can always go back and edit.
What does your ideal career look like?
What does your ideal workplace look like?
What’s your ideal schedule?
How does self care fold into this plan?
What are your dealbreakers? How will you know when enough is enough?
After you have figured out your own boundaries (the dreaded boundaries!), it may be helpful to sit down and communicate those to your supervisor. In your next job interview, interview your interviewer. Ask them about the things on your list. If something doesn’t line up, wait for the next job opportunity.
You can certainly approach your healthcare career without thinking strategically about your well-being, but it probably won’t turn out well in the end.
Compassion fatigue builds and builds and builds until you are a shell of your former self. You may have trouble remembering why you went into healthcare in the first place. You may feel your suit of armor stiffening and creaking. Your gallows humor may get too crass for your co-workers to stand. You may begin to take your flippant attitude into your interactions with patients. You may start having thoughts that are darker than you thought were possible.
The stakes are high, but there is hope.
Whether you are new to healthcare or are a seasoned veteran, you can start to make a plan for your own well-being now. Try answering the questions above AND join the email list (scroll to the footer, below) to download the free Cared to Death Safety Plan (this will help you know what to do when you are freaking out on the inside).
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Tell Jamie what compassion fatigue issues are nagging at you so she can write about them.
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