Ep #172: Compassion Fatigue

Katrina Ubell:      You are listening to the Weight Loss for Busy Physicians podcast with Katrina Ubell, MD, episode number 172.

Welcome to Weight Loss for Busy Physicians, the podcast where busy doctors like you get the practical solutions and support you need to permanently lose the weight so you can feel better and have the life you want. If you're looking to overcome your stress eating and exhaustion and move into freedom around food, you're in the right place.

Well, hey there, my friend, welcome to the podcast. I'm really glad you're here today. If you are new, I want to welcome you and just help you to know that you are in the right place. I know that a lot of you are struggling right now, especially if you're on the front lines and taking care of patients with COVID-19 or if you're a physician and actually not able to work right now, you might really be struggling as well in your own different but equally valid way. And so I want to start off this podcast by offering you a few resources that I have that I want to make sure you know about in case you are struggling. So the first is episode 108 of this podcast. It's titled Everything is Awful and I'm Not Okay – Questions to Ask Before Giving Up. And that is basically this one-page form that I honestly don't even remember now how I found that thing or if someone gave it to me, I don't remember.

But anyway, I found it digging through and decluttering my house and I thought, “You know what, this is really, really good, I need to share this.” And it's really basically like a checklist step-by-step when you're feeling like everything is horrible and you're not okay, start by going through this checklist. So if you're finding that you or someone you know or love has really been struggling, I want to really encourage you to go to that episode, listen to me go through all the different elements and give my coaching take on it all. And then you can also go to the show notes page and get the actual PDF as well. You can find that at katrinaubellmd.com/108. The number is 108. So Everything is Awful and I'm Not Okay, is a really, really good one for you to know about and to offer to other people that you know are really struggling.

And then I also want to let you know that I've been offering some free coaching calls for healthcare workers for the last number of weeks, many weeks, and those recordings are available to you to be able to listen to as well. Once you basically give us your information so that you can get those call recordings, you'll also get the information that you need to be able to possibly attend one of my future free coaching calls for healthcare workers live. So make sure that you go and sign up for this and you can listen to these call recordings when you're in the car, when you are out for a walk, when you're cleaning up around the house. We're all cleaning our houses now, doing our own laundry, things like that, you can listen to these calls and get the help that you need as well.

I think a lot of what you hear me coaching on is going to be relevant to you, so you can get those by going to katrinaubellmd.com/calls. That's how you're going to get those recordings so that you can get some good help and really get your brain in the right place to be able to sustain everything that you're dealing with right now for as long as we need to sustain it. So make sure that you share those with, like I said, anybody that you know who's struggling right now, anybody who is a healthcare worker or honestly, anybody who's really struggling with pandemic could really get a lot of benefit from this.

Okay. Today I want to talk about compassion fatigue because I know that this is something now that we're a number of weeks now or over a month into this in some places, I know that compassion fatigue is something that many of us are struggling with. And we're not only struggling with having compassion for others or the people we're taking care of. We might be struggling to have compassion for other people in our lives or even potentially ourselves.

So there's a very classic way that compassion fatigue is discussed in the literature, in psychology literature, psychiatry literature. I want to discuss that with you a bit today with some solutions for you, but I also want to talk a little bit more on how this applies to you and your relationship with yourself as well. So Charles Figley was the person who described compassion fatigue as a thing, and the Figley Institute has a free PDF. It's a Basics of Compassion Fatigue workbook that you can access. I just found it for free online. And I just wanted to read to you what their description is of what compassion fatigue is because they also talk about it in comparison to other forms of trauma and stress and things like that.

They described it this way. “Compassion fatigue is a recent concept that refers to the emotional and physical exhaustion that can affect helping professionals and caregivers over time. It has been associated with a gradual desensitization to patients' stories, a decrease in quality care for patients and clients, sometimes described as poor bedside manners, and increase in clinical errors, higher rates of depression and anxiety disorders among helpers and rising rates of stress leave and degradation in workplace climate. Helping professionals have also found that their empathy and ability to connect with their loved ones and friends is impacted by compassion fatigue. In turn, this can lead to increased rates of stress in the household, divorce and social isolation. The most insidious aspect of compassion fatigue is that it attacks the very core of what brings helpers into this work, their empathy and compassion for others.”

I really like that description. I Actually read a lot of different things about compassion fatigue and that was the best description that I found. I really like that at the end it talks about that paradox. You went into this profession for a reason, you wanted to help people and now it's backfiring in this certain way. That can be so depleting that it really takes away all the things that are important to you in your life. So let's dig into this a little bit further. So who is at risk for compassion fatigue? I think really all of us are at risk ultimately. Anybody who is helping, who is basically alive right now potentially can struggle with this. I was even reading that some people are saying that just day to day regular people are experiencing compassion fatigue because of what's being broadcast on the news so often. There's so many stories of people suffering and having a hard time and the environment being attacked and animals suffering, and we have so much compassion for all the different issues that are going on that before we know it, we're in a compassion fatigue state.

So I just want to say that I think probably all of us are at risk for compassion fatigue in one way or another, but I think that there are certain characteristics that set you up to be more at risk. And as I was going through these and learning about these, I was like, “Oh boy. Yep, I know. That applies to me and it's going to apply to a lot of you as well.” So definitely pay attention to this. So, if you have an overdeveloped sense of responsibility, you would possibly be at risk for compassion fatigue.

So I just think of so many of us who were that totally conscientious little girl, who just was very responsible and got her work done and we were our worst critic. Nobody had to tell us we did something wrong or punish us because we were harder on ourselves than anybody else could be, the sense that you need to be responsible to everybody but to a fault sets you up for compassion fatigue. Because then when you feel like you're so responsible to others, then you're going to be giving, giving, giving, giving, giving like crazy and not taking the time to rejuvenate yourself and refill yourself back up. So overdeveloped sense of responsibility.

Having a lack of strong personal boundaries. So that basically means letting everything and everyone into our lives, not having a boundary on, right now, the social media intake that you have, maybe how often you're looking at news or news reports or statistics, death rates, infection rates, who's traveling, what's happening in other countries, what you're discussing with other people. Let's just say that you know that if you get on the phone with your parents, they're going to be talking about how they think all of this is a big conspiracy, whatever they may be talking about and you know that that is very depleting for you, it is available to you to set a boundary with them and say, “I love you so much. I'm so glad I'm talking to you, but I don't want to talk about the virus. Let's talk about something else. Let's talk about what the weather's like where you are. Let's talk about what you've been cooking lately. Let's talk about how your dog is doing.” Like any other topic.

And you can even direct that sometimes on your own by just asking other questions. But when you get really clear on what your personal boundaries are, that gives you like the bumpers. Think about bumper bowling. That's the kind of bowling that you can do where they put down the bumpers on the side so that the ball can't go into the gutter. Like think about having those boundaries in place to keep yourself going in a track and on a path that actually serves you. So you have to be very clear about what is actually useful and helpful to you and what isn't, and then create those boundaries.

If you have some unresolved past pain and trauma, then that for sure can put you at risk for compassion fatigue. I want to make sure that it's clear that you definitely could have some trauma from your medical training. And I think sometimes we get to really kind of like, “Wow, that's just the way it is. That's just the… I just was in a malignant program and you know it's not a big deal. Of course everyone screamed at us and whatever.” So I'm not saying that it's necessarily something that prevents you from functioning normally, but it might be something that puts you at risk for something like compassion fatigue.

So I just think it's something to put out there. Something to mention for you to think about. If there is some sort of trauma or emotional pain that you still have going on for you, especially as it comes to taking care of patients or being in a medical environment, then that would be something that could put you at higher risk as well. If you have the impulse to rescue anyone in need. We often think of this as being such a great quality, wanting to just get in there and, “Who needs help and I'm here and I'm going to do what I can do,” everything I can do to help. Yeah, that can be helpful to a certain extent. But again, when you're giving, giving, giving constantly, then you're setting yourself up for compassion fatigue. And that leads into the final one, which is really being focused on others. Being completely centered or directed to see what others are needing.

So you're taking care of everyone else first. And this is so often what's modeled to us and then also what we fall into when we're out into our lives with families and other people who rely on us. We come last. We take care of everybody else, we take care of all of our patients. And if you have trainees that you're taking care of or mid levels that you work with or whoever, that you're taking care of everyone else, maybe your employees right now, you work on taking care of them. And I don't think that's always bad. As we often say in the business world, when you're the owner, you eat last. So if you are a practice owner, that might be the right thing to do. But what happens then when we try to take care of ourselves is we feel really selfish. We feel really self-centered.

You might feel some shame over even giving yourself or your needs any attention when all these other things are going on for other people, that's going to set you up for compassion fatigue because you're not believing that you're deserving of any of your focus or care that others deserve all the care first. So all of those things are possible characteristics of factors that could put you at risk for compassion fatigue. Now, like I said, even if you don't have those things, you still might find yourself experiencing some symptoms of compassion fatigue. So let's discuss what those are. So this first one I think is one that I'm like, “Wow, I think maybe I have this chronically and it's wanting to isolate,” but I guess I should say the caveat is usually I'm wanting to get some time alone so that I can rejuvenate myself and then come back.

This is the kind of isolating that you want to do where you have nothing left to give and you're like, I need to get away from everybody because I literally don't have one drop of energy left to give to anybody else. And so if you're working all day or struggling with your practice and trying to figure out a solution all day long, which is very depleting for you, then when you're coming back together with your family, with people who are important to you, you're just checked out, you're not wanting to actually be present with them. I think one way that we isolate emotionally, so physically we're there, but we are not there emotionally. We're not actually mentally present at all, is through food and alcohol. So that's when you're pouring yourself the next glass of wine. The kids are talking about whatever and you're completely tuning them out as best as you can.

You are going back and getting more to eat. Maybe you've started doing a little bit of binge-like eating behavior, just trying to make the emotions go away. Trying to numb yourself out. That is a way of isolating from what's actually happening in the world for you. So that one I think is really, really important because a lot of people are going to resonate with that one. Another symptom is emotional outbursts. And what happens with that when you don't know how to process your emotions, you don't know how to identify what your feelings are and you don't know how to allow them to pass through you and be processed and then move on without a reaction, without needing to avoid it, without needing it to go away immediately. Then what you end up doing instead is you stuff. “Who's done this?” You just can not swallow that emotion.

You stuff it down, stuff it down, stuff it down. And what happens here is, you stuff and stuff and stuff, those emotions until at some point you just erupt and it's often over something that's totally irrelevant to what's really going on for you. And like you're making a huge mountain out of a molehill. So for instance, one of your kids ends up spilling something sticky on the floor and you just lose your mind. Not that I've ever done that. So it's not about that. Who cares? So there's something on the floor, you clean it up. It's not a big deal, but it's just this release of all these other emotions. Now what happens when you have these emotional outbursts is then most of us end up beating ourselves up for being mean to our kids or not responding in the way that we should, or not being as kind and compassionate and loving to them as we feel like we should be.

So we release all those emotions we've been stuffing and then we take that as an opportunity to beat ourselves up and remind ourselves of what a terrible job we think we're doing. So I'm familiar. So if you are having those outbursts where you are freaking out on people, that could be a symptom of compassion fatigue. Another symptom is substance abuse. So that could be the typical things that we think about like self-medicating with drugs, alcohol, cigarettes, porn, gambling, you name it. But I think that so many more physicians are self-medicating with food and alcohol right now. So notice if that has been what you've been doing. I think this is very different than if you've been like baking more with the kids because they're around and you're like, “This is a good opportunity for me to actually teach you how to make some of these things and this is like a life lesson and Oh you've been eating more of those things.”

That's totally different. Also, maybe not super helpful for you, but that's totally different than using food to self medicate where maybe you are baking things or you're buying things or you're ordering out having it delivered and you're just eating and eating and eating in an effort to try to just numb it all out. Just trying to make it better. So again, same thing with drinking where you're having your wine or your beer or whatever it is, and another cocktail and another cocktail trying to make it better for yourself. That's a symptom of compassion fatigue. Another one is constant companion of apathy or sadness. So apathy is just like lack of caring, lack of energy, just like what difference does it make is anything I'm doing even making any difference, which I think a lot of physicians will be feeling now because they're doing everything.

You're doing, everything you can do and people are still dying and there's so many things that we don't know and we don't know how to really best help a lot of people. So there's that constant companion of some apathy and or some sadness where there's just this over whelming veil that's over everything of sadness. You're not able to leave it at work and come home and really connect again. It's always there even when you're not in the work environment. Another symptom of compassion fatigue is an us versus them mentality. And I immediately was thinking about residency and medical school where it was so us versus them and sometimes it was, if you were on the floors, it was us was the floors and them was the ER. And who happened to be the attending in the ER and whether they were seven or not and how that all worked.

And then when you were in the ER, us was you in the ER and them was the people on the floor who were taking forever to get that patient out of the ER so you could keep your rooms moving and all of that. So us versus them can show up here in so many different ways. It can be them right now for you can be all the people who maybe aren't social distancing the way they should be. I went out for a walk this weekend and I definitely saw people who were not following the recommended guidelines and what you think about that.

If you make that into something where you're so frustrated because you're working so hard and it's like almost your interpretation of them being out or doing those things is like a personal attack on you. You might have some symptoms of compassion fatigue. And then even within the hospital there might be some us versus them between different parts of the team. The medical team maybe between the ICU and the floor or all the different people in the hospital who are taking care of patients and the whole workflow for everybody right now. So be on lookout for that. And then more significantly some symptoms of compassion fatigue can be flashbacks and recurring nightmares.

And I wanted to mention this because I don't know that this necessarily is happening for a lot of people, but if it is, this might be a sign that your symptoms are a little bit more significant and that you might want to seek some professional help from a therapist or a psychiatrist who really understands compassion fatigue and possibly trauma as well and really working with somebody through that. The great news is that so many people like that are able to do TeleVisits right now. So you would be able to do it hopefully from home whenever it's convenient for you. So I just want to mention that if you're having those flashbacks, you're having the recurrent nightmares as something to take seriously. I mean all this is something to take seriously, but if it's getting to that point, you definitely want to speak up and get some help.

So then, how do you work through compassion fatigue? Because we have these symptoms, We want to isolate from ourselves. We don't even like being with ourselves, which is why we're wanting to eat and drink and try to avoid all of it. Watch all the shows on Netflix and escape into social media. We don't even want to be with ourselves. We don't even have compassion for ourselves. We beat ourselves up when we do things that we think we shouldn't be doing. And so how do we work through that? All right, well, so I have already done a comprehensive episode on why self-care isn't selfish. It's actually called why self-care isn't selfish. It's episode 138 you should definitely check it out, but one of the most important ways to work through compassion fatigue is a sustainable self-care plan that works for you. And you're going to have to spend some time with yourself figuring this out.

This is often a reason why people don't do it is because they're like, “I don't like being with myself. I am so mean to myself. It's so uncomfortable for me to just be with myself. I just want to be out there helping anybody I can, who's in need I'm just going to go out there and help them, except that's what puts you back into compassion fatigue when you just do that nonstop. You have to find a way to spend some time with yourself and figure out what ways you can refill yourself back up and actually renew yourself and love on yourself. Really have some compassion for yourself as you work through this as well. When everybody talks about finding a balance life, it's like what does that even mean? Is there a balance but I would just say that you need to figure out a way to create that renewed feeling within yourself so that you feel like you're refueled again before you go back to work.

So whatever that looks like, then that is the balance for you. It doesn't mean the same amount of time. It's not like a time exchange. It's going to be definitely more just, “What do I do? What can I do that makes me feel up to going back to work and being at my best or close to my best?” I think that first, so many physicians, the most important self care tool that you can take advantage of is going to sleep. And everybody talks about this and then we still stay up too late. And I want to just bring it up again that when you're thinking about, “Well, what am I supposed to be doing? What should I be doing?” Go to bed. Go to sleep. Just try it for a week. Just try really sleeping a lot for a week and see how you feel. Just do it as an experiment.

You're not saying you're never going to watch shows after the kids go to bed. You're just saying, “I just want to see how I feel when I'm really well rested.” So give it a try and see how you feel. And you might find, “You know what, I don't need to sleep quite that many hours, but wow was work so much better and was my mindset so much better when I got eight or eight and a half hours. That's really interesting. What can I do to try to protect that? To make that a possibility for myself at least most of the nights of the week, at least the nights before I have to go into the hospital to work or into the office?” There are so many other ways that you can take care of yourself. So definitely check out episode 138 about self-care. Another way to work through compassion fatigue is to be really deliberate with the empathy that you offer.

So this goes back to what I was saying before, when you are just offering empathy to everybody and anybody all of the time. You need to be real clear with your boundaries on who is getting the empathy. So if you watch video after video of first responders and how difficult their experiences right now, this pandemic and listening to recordings of physicians talking about what's going on, and going on social media and reading all these posts and looking at these pictures, you are then just giving away all of that empathy and not refueling yourself. So it's fine to feel empathy for those people, but is it really helping you in a way that moves you forward? So again, you're offering empathy to these people that you don't know, can't feel what you're doing. You're not helping them at all by offering your empathy, if anything is just depleting you.

So maybe you still want to do that, but I just want you to consider being very, very focused and intentional about where your energy goes specifically when it comes to empathy, because you are already at work offering a ton of empathy. Even if your practice is closed right now, you're still offering empathy to your employees that you are trying to keep up and running and financially solvent and hired. You need to offer empathy possibly to your spouse or your children, but also offering it to yourself. This is a very hard time, completely unexpected, and there's no precedence set on how to deal with this. So you're figuring it out as you go. And as I like to say, you're going to fail forward and you're going to screw things up and you're going to see the wrong thing. You're going to mess it up big time.

And when you offer yourself empathy, you pick yourself back up again, dust off your knees and you keep moving forward. That's empathy that is actually well spent versus just empathy for all the people out there. We love them, but we don't need to be utilizing all our empathy on them. Another way to work through compassion fatigue is asking for help. And right now that's really can be tricky, because you can't have people come over. You can't have a babysitter come over. In fact, the usual ways you were getting help if you had any household help, you can't do any of those things either, but you can ask for help with the people that you have in your home. And if you don't have anybody in your home, then you can ask for help even virtually. And asking for help might seriously be reaching out, having a virtual coffee time with somebody over Zoom or FaceTime.

Often there's neighbors who are across the street having a little happy hour time together and talking with one another, asking for help in that way. Asking for help like, “I need someone to listen to. Could you just check in with me every day? I need to feel some connection with some other human beings because I'm alone in this house so much all day long.” It's really getting hard. Asking for help from family members. “Hey, could you text me every day? Can you give me a call every day? I just really need that connection right now.” That might be all that you need so that you don't feel like you need those people to come in to help you if you can't have that physical help. Another one is exploring spirituality. And this does not have to be any formal religion or anything like that.

Really, the spirituality is a reconnection to something bigger than yourself. Why are you even here and what is the whole point of doing all of this stuff? If this is something that stresses you out and does not help you, then you can just leave it. This is not something that is required, but for a lot of people that reconnection can be very, very meaningful and is a really nice touch point for them as they work through compassion fatigue. So if that's you consider that. All right. Practicing gratitude and appreciation. What are the good things that are going on? What are you seeing that's actually great? What are you grateful for and who are you grateful for and make sure that every day those are different people and different things. That is a practice, there's tons of research on it now. It really, really helps get yourself to a place where you are filling yourself up.

You're not just telling yourself the story of how everything is terrible, what was all of us, this is the worst thing in the world. It really gets you focused on seeing the good that is actually out there and waiting for you to notice. And then practicing mindfulness. And I think mindfulness is one of those things that is that hot topic people talk about it all the time, but I wanted just to tell him briefly into what that actually means, practicing mindfulness. What it means is that whatever you're doing in the moment, you're 100% present with it. So this is very, very useful for you when you are working or when you are figuring out your finances or figuring out what the next step is going to be for you. What it means is that you are focusing on the thing in front of you and nothing else.

You're not letting your brain go to the future and what if, and I have to go to this thing after and I have to help all those people afterward. What are you doing right now and do that very well with 100% attention and you're mindfully focused on it. And all you have to take care of is the person who's in front of you right now. So that when it's time to move on, you finish that, you leave that person, you go move on to the next person and now you get to fully focus on them. And that is such a relief to your brain. Your brain doesn't have to be juggling everybody all at once and thinking about all the people waiting. The how long the line is. And how all the patients are the same and which ones are you going to arrest in the ER and which ones are you going to have to intubate?

Who do you have in front of you right now and what do you need to do to help them right now? When you're home be 100% present with what you're doing. Put your phone down, even if you can just do it for 30 minutes, just put it away, don't have it on your body and actually connect with the humans that are in front of you. You don't need to isolate yourself by escaping into the phone and isolate yourself from them and from yourself. You're saying, “I can't even be with myself. I need an escape.” So see if you can practice it even just a little bit. It's like a muscle that you're going to get better at developing when you practice it again and again and again. And what all of these things that I addressed do is they build resilience.

And that's really what you need to keep going through this day after day, week after week, possibly month after month, even after the really bad days, even after you feel like, “You know what, that was our worst day yet. How could it possibly get worse than the day after that?” It gets worse. You have to keep focusing on these things to work through that compassion fatigue and really build yourself up, so everyday you can come back with that renewed energy and renewed focus and renewed passion to help people. And that is how you're going to get through this in a way that doesn't completely deplete you and make you so burned out and so sick of medicine that you're ready to quit and find something else to do afterward.

So please, if this was helpful, share it with everybody that you're working with, everybody you know that might be helped with this information. This is something that I wanted to get out there because I know it's going to help so many people, so please share it if you know anybody who is struggling right now. If it's helpful for you, wonderful. If anybody you're working with or anyone you know is struggling, please feel free to suggest it to them as well.

Okay. Listen, you are doing a really fabulous job no matter what. You're doing great, and I know that because you're here and you're listening, I just want you to know that I have mad respect for you. You're doing it. You're showing up every day. It's going to be amazing at the end when you look back and realize, “Look what I was able to get myself through, my family through, and I'm improved on the other end because of it.” So I love you and hang in there, friend. You've got this. Talk to you next week, bye-bye.

Did you know that you can find a lot more help for me on my website? Go to katrinaubellmd.com and click on free resources.