Healthcare Professional Burnout and Resilience

The Hard Edges of Compassion

Upon reflection on my first year as an AMS Phoenix Fellow, I did not anticipate how challenging it would be to explain my work on compassion to others. The standard reaction is “Oh…how nice!” Nobody ever says, “Compassion? Why would you care about that!” However, I don’t sense true understanding of the dire need right now for compassion in health care from outside of the AMS community. Therefore, I am profoundly privileged to be part of this organization and be identified with a group of conscientious disruptors and innovative change makers.

If you have read my previous AMS blog, you will know that I’m working on a better definition for compassion.  At least, better in the sense of how I am understanding the concept for myself and in my research. In case you are wondering, here is where I’m at now:

Compassion – caring space for empathy, understanding, and hope, inspiring action, connection to self and/or others, and attention to what we truly value. It allows for a different perspective of the world and self in relation to others, acknowledging common humanity in terms of vulnerability and shared brokenness.

But… “why does compassion really matter, anyway? Why am I doing this work?”

Recently, I received an email advertising a newly released documentary- “Do No Harm: Exposing the Hippocratic Hoax”.  It will be launched as an international film tour in the Fall and there will be presentations in several places across Canada. “Interesting,” I thought. Then I wondered, “Why now, is this a new phenomenon?” Later that same day another email – a new book out, published by the American Psychological Association (APA), addressing the issue of physician suicide as an occupational hazard. Being a nurse, I immediately thought, “What about nurses?” I jumped onto the internet and found two blogs written on this topic earlier this summer Nurse Suicide: A Silent Trend and  Preventing Nurse Suicides.

So, not just physicians. Nurses too. Then, in the second last week of August I read an article in the National Post (August 24, 2018) that sadly reported that three OPP officers had died by suicide in the last three weeks.  These officers were also part of the team of failing systems of health and social services. What role did compassion (or the lack of) play in this final outcome for these doctors, nurses, and police officers who saw death as their only option? These are just a few examples.

In 1992, a nurse named Carla Joinson wrote about compassion fatigue and used it to describe professionals’ experiences with being part of crises in others’ lives. She called its effects “emotionally devastating.” I agree with her assessment of the effects, but not all of what she wrote to describe this phenomenon. I have never found the work on compassion fatigue to ring true for me personally. I struggle with the early definitions of the condition. It wasn’t until I came across the work of Jonathan Shay (2014) and the term “moral injury” that I really had an ‘ah-ha’ moment. His work with the military identifies moral injury as occurring when there is a betrayal of what’s right, by a person in power, in a high stakes situation. There it was! Now that’s what I had been looking for. Past compassion fatigue and beyond moral distress (my research passion for over 10 years).

So I took my thoughts on all of this to my AMS Fellowship Mentor, Dr. Michelle Spadoni. I said, “Michelle, can I write about this in my next blog? What do you think?” In her quiet way, she paused and took a moment to consider what I had just asked her.

“Kristen, are you saying that compassion is radical?”

“No! Well, not really. Maybe?”

“Kristen, the history of the word “radical” means rooted. What we are learning in these moments, is that compassion is not just the soft stuff. We need to dig down. It is the ragged edges and sometimes the unanswerable. Right now we are fumbling. It is so difficult and it is not just now. It has been happening for a long time. We are just starting to talk about it. No longer just whispers in the stairwell. Recently, I heard an intense conversation on White Coats, Black Art; a physician talking openly about her own depression and experience of burnout …We are all in the muck of it…”

So often we see images and hear discussions about the soft sides of compassion; the hand holding, the kind words, the cup of tea. That compassion is an inherently human quality, instinct really, and the common foundations of all major wisdom traditions. Some say that the Arabic history of the term compassion relates to the word for womb and the archetypal expression of a mother’s love. Compassion can be our greatest resource (e.g., providing balance, meaning, purpose) or our greatest source of suffering (e.g., causing anger, isolation, desperation). I am inspired to continue to learn more about the paradox of compassion and all facets of its dynamic complexities.

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