In this MedPage Today video, psychiatrist Jessica (Jessi) Gold, MD, MS, of Washington University in St. Louis, addresses the emotional wall that many healthcare workers currently face as they struggle with the ongoing COVID-19 pandemic.
The following is a transcript of her remarks:
When I like to think of compassion fatigue, I think we throw a lot of terms around, we use, like, burnout and moral fatigue and we use them all kind of interchangeably and they’re quite different actually, but compassion fatigue itself is really like the cost of caring for someone.
So if you really are a person who’s empathetic and you went into a caring profession where you are every single day, day in and day out, listening to people, taking care of somebody else, you end up taking on a lot of what they’re feeling. And sometimes that can be really hard if what they’re feeling is anger, and that can be really hard if it’s not matching up with actually getting care, like if they’re coming in not having done what they should — quote, unquote — be doing to get healthy themselves.
And I think what happens in a lot of ways is we take on the suffering of other people. One of the quotes I often think about is, “it’s both a blessing and a curse to care very deeply.” And I think that that’s kind of what compassion fatigue really is in a nutshell, which is when you care about people it takes a toll, and that’s what happens over time in these jobs, you just can’t handle it anymore.
When I think about examples, there’s so many on social media right now, I mean, over the weekend even, there was a nurse that posted about how somebody’s dying words were, “I’m still glad I didn’t get the vaccine.”
Which, I mean, imagine having put everything into trying to help somebody, and your day is really long and you’re exhausted, and you’ve been working on COVID shifts for a year and a half and seeing more death than you’ve ever seen in your life, and risking your own life and your family’s lives — it’s a lot to then have somebody still kind of be like, “screw you,” and die themselves. So I think that that in itself is really hard.
I’ve been reading a lot of stories too on social media of people where, even when their family members die, that person still says, “that’s not COVID” and things like that. And I think that can be pretty painful for people. And I think after a while, what happens is what people are seeing expressed on social media is just like this fatigue and emotional exhaustion and almost like, “I just can’t take this anymore, I care so much about people but I just don’t know how to care about this in the right way” or “I don’t know how to express this in a way that people understand and won’t judge me for how I’m feeling, but I’m so angry and so sad and so anxious and so all of these things at the same time that it’s just so hard day to day and it’s contributing to the entire complex of everything that I’m feeling” and I think it’s really just challenging to have that compound everything that people are going through.
I think there’s this argument that we’re supposed to robotically take care of people and not express how we feel about doing so, that we’re not supposed to have anger, that we’re not supposed to feel sad, that we’re not supposed to be anxious, and I think that’s not fair. We’re human, and we entered a human profession and we’re empathetic human beings, and it’s been a really hard year and a half or more, and to pretend it hasn’t isn’t fair.
And so if you’re somebody who is a physician or a nurse, or another healthcare professional, or somebody in another field entirely, and you’re reading these statements by healthcare workers and you’re saying like, oh, it’s against the Hippocratic oath in some capacity for people to be expressing anger or for people to be having these feelings out loud or for people to even be exhausted by this group of people that isn’t — quote, unquote — listening, I think what you have to realize is that they’ve never even expressed these feelings out loud before. We’re not in a profession that is even really allowed to feel. It’s not something we’re really taught to do, it’s not something we’re often allowed to do — we aren’t often given space to do it either.
And we’re in this situation where we’re tired, we don’t have any space to sleep, or even really fully process everything that we’re dealing with. And you get like 10 seconds on social media and you say how you’re feeling because maybe you don’t have as good of a filter as you wanted. And maybe that’s not exactly the most polished way of saying it, but I think that you’re allowed to be angry and still be a good doctor. And you’re allowed to, you know, be anxious and still be a good doctor.
And it doesn’t mean that people aren’t taking care of their patients — when people actually see those people in their waiting rooms or in their offices they’re taking just as good care of them as they are anybody else. I think it hurts them more, I think seeing resources be spent and us not having beds for other people or people being unable to get care for things like strokes because there’s no beds because people aren’t getting vaccinated, I think really does hurt people. And when they say that stuff, it’s not just lies. But I do think that you can really express those things and not mean, “now all of a sudden I’m not going to care about anyone and be a horrible doctor and just let people die.” I think it’s just an expression of, I’m really sad right now or I’m really angry right now, and both things can be true.
The easy question is to say, how do we fix it so people can take breaks and go on vacation and actually say, “I can’t be here right now because I’m not working at the best of my capacity and I need to actually refresh and spend time on me before I can be able to spend time on someone else.” And that’s the answer I would love to give, to say that we should say that if we’re not able to give the energy and time and ability that we think would make us the best person to be in that profession right now, that we should be able to step away and say we need space and time for ourselves. But it’s so hard right now to even fathom giving that answer without healthcare workers watching this and laughing at me, and saying that’s a really good idea, Dr. Gold, show me how that’s possible! And I agree in a lot of ways that that’s sort of like an idealistic goal right now.
That would be like the A+ goal in the future maybe. I think right now what you have to do is, where are the little times that you can focus on yourself. Are there times throughout the day where you can take a little break and say, this is me time. This is the time I can actually say, this is where I only focus on me. I don’t focus on other people. I ask myself how I’m doing. I don’t only focus on the care of others. I take a total inventory of what I’m feeling in my body, what my emotions are telling me, and then I try to figure out how to cope from there. And that includes eating and sleeping, and hanging out with people who might make you feel better, or coping skills that you have enjoyed in the past. So maybe that’s journaling, that’s meditation maybe, that’s going for a walk maybe, that’s watching stupid TV. Whatever it is, I think all of that is really important.
I think also making sure that sometimes because we’re in caring professions, other people also make a lot of demands of us, in our personal lives. Our friends and family can ask a lot about what it’s like at work and what it feels like day to day to be on the wards, and “is it as bad as they say,” and ask us for horror stories. And I think we have to draw limits and say, “listen, I can’t talk to you about work, it’s not good for me. I’ll talk to you when I need to talk to you and it’s actually healing for me to talk to you, or I feel like I need to talk to someone. But otherwise I can’t bring work home, I need to talk about other things. Literally there’s COVID everywhere, and I need to have some sort of boundary.”
And I think that’s really important because otherwise people think they’re supporting you, but also there’s some kind of like voyeuristic aspect of it, because you’re their only link to reality because there’s no cameras on a ward and there’s no, you know, ability to actually see what that’s like and then carry that into their people. And it’s not your job to be the reporter for everybody. It’s nice to think that you can save the world by being the person who tells all these horrible stories, but it’s not your job to do that all the time. You have to take care of yourself first, and if that means drawing boundaries to talking about it, I think that that’s important.
I think that’s the same on social media. So I think social media can be a wonderful place of support for healthcare workers, and I’ve seen it be a place where people feel like they can freely express this stuff, and get a ton of support back from people saying, “I see you, I’m seeing the same stuff, I just want you to know I care about you,” and that feels really nice.
The only other thing I would say is if you feel like this crosses over to the level where you’re not sleeping or not eating, you’re not functioning, it’s interrupting your relationships, it’s really affecting your day-to-day life, you’re not feeling like the person that you were before, your mood is off, you’re not interested in the things you used to be, you’re so worried about things that you can’t do, things that you used to like or that you are avoiding things every time you think about going to work, you get really anxious, things like that, you should get professional help. And it’s not a weakness to get professional help. I know we’re in this career that thinks we’re supposed to just tough it out and not get help, and has a huge stigma to seeing somebody like me, but I really think that we can’t do that anymore. We have to change that, we’re giving a lot to other people, and if you didn’t need help for this I would be surprised. So, if you start to feel like talking to someone could be beneficial, like getting medication might be beneficial, none of these things are things to be ashamed of. You really are helping others so so much, and if you need to get help for yourself, please do.
Jessica (Jessi) Gold, MD, MS, is an assistant professor in the Department of Psychiatry at Washington University School of Medicine in St. Louis.