Saturday, November 9, 2013

Compassion fatigue.

It's something every vet student hears about, has lectures on, awareness raising on social media about it... Compassion fatigue is, if anything, overly-emphasized in vet med. And for good reason. Our profession has an alarmingly high burn out rate, and suicide rate. My own professor, when lecturing on the topic, brought up a vet who she went to Ross with who had committed suicide with Fatal Plus euthanasia solution and an injection pump machine from her own clinic.

Today, Dr. Wallace, my beloved large animal medicine professor, linked to this article on Facebook. I'll quote the portion that made my heart clench in empathy:
"Veterinarians are determined, driven, type A people. We as a species hate to give up, we loathe defeat, and we give until the bank is empty. Our ability to maintain a level of empathy for every client, every incident and every patient is unrealistic. How does a normal rational empathetic person put a pet that they have watched grow from infancy to geriatric to sleep in one room and then walk ten feet away to another patient who you are expected to be jubilant and clear headed to examine, diagnose, and treat? Somewhere along the way we learn to mask, shelter, or disregard our emotions. Somewhere it became expected, and we learned to push feelings aside and press on. It is a recipe for a psychopath and a schizophrenic. And we do it every single day."
She goes on to say that we need to take better care of ourselves. Pay attention, stay clued in to what our bodies and our minds are telling us. Look for patterns of substance abuse or coping mechanisms in our own behavior that are red flags. And set boundaries. Learn to say no to clients.

It reminds me of a conversation I had with a clinician when my septic, failure of passive transfer calf was dying. I was watching him lying on his die, struggling to breathe, groaning with every breath, and just clearly in abject misery. He was receiving excellent care. He was on pain medication. But he was still suffering, because he was just continuing to get worse with no hope of cure. We were playing catch-up with his suffering as he continued to plummet.

I asked the clinician, "Have you ever reached a point where you fired a client because they wanted to keep going, but for your own sake of mind and your personal, ethical considerations you felt it was wrong to do so?"

He said no. He said we can control suffering with pain medication, or even induced comas if necessary. He said the owner had to reach the conclusion to end life on their own.

I agree, to an extent. I understand his position. But I disagree on one basis, and that is the sake of my own mental health. Yes, ideally the owner should decide to euthanize without you pressuring them to do so. Saying, "Euthanize or find another vet." definitely falls under the realm of pressuring a client. But if I am treating a patient past my comfort level, and I am upset, and do not want to continue, and feel it is wrong to keep going, and I do this often enough, I feel that I will burn out.

I had this exact conversation again with the anesthesia technicians when we had a particularly nasty case come in and everyone in the room felt that elective surgery in an animal that old and that ill was probably not in the animal's best interest. The technicians agreed with me, and said that they would be more apt to work with a veterinarian who set firm personal boundaries regarding quality of life than one who kept going in the face of suffering.

It helped re-establish my gut feeling that I am not being selfish, or a bad person, or a bad doctor, if I establish boundaries with my clients regarding end of life decisions. I'm pretty confident in my decision now that I will reserve the right to gently, but firmly, show them the door if need be.

No comments:

Post a Comment