What does compassion fatigue feel like?

“I am just getting through the day,” I tell myself. “I will do my job and do it well and go home to my family. On time.”

I am in a Covid room, the rubber gas mask strapped tightly to my face. The patient cannot hear me through the thick material so I yell louder. The patient tells me he is frustrated and wants to go home. I nod in sympathy even if I do not feel it. He is the 6th patient to tell me this. I glance at the amount of oxygen needed and tell him it is not safe. He is the 6th patient I say this to. The patient is frustrated, tired, bored. I tell myself I should not care.

A nurse comes up to me, says that one of the other patients would like to go home and is frustrated and tired of being in the hospital and could I talk to the patient or the family. I nod in sympathy even if I do not feel it. I say that I am not going back into the room, having already examined and discussed and set an appropriate plan of care. She understands. I tell myself I should not care.

Another nurse comes up to me and says… the same thing. I say the same thing. I tell myself the same thing.

I sit down to type my notes. I am famous for writing ones that are long and detailed because I always worry about something unexpected happening overnight and so want the covering doc to have a little extra info even if it’s a little redundant. But I stare at the screen and decide to try and write less. I tell myself I should not care.

I hear a nurse call out worrying vital signs. She is not talking to me, it is not my patient, but I know exactly what is going to happen next. I see more staff come running. I watch the ICU team swoop in. I turn back to writing my notes. I tell myself I should not care.

Someone I know texts me a question about Covid. Another is texting me about all the things I should be doing differently (even though they are not doctors, but repeating what they heard from other doctors who say things that were once reasonable ideas that are now clearly objectively bad ideas) and things like letting people choose and freedom and blah blah blah. I tell myself I should not care.

An exhausted nurse walks by and stops, surprised, to ask, “Doc, you still here this late?” I laugh and respond, “what about you?” and she says “yeah 40 years and I never get home on time” and I reflexively say what I used to always say which is “me neither” and…

I check the time. I am an hour late getting home. And I am mad at myself because I actually did spend 15 min looking for a book and only found trashy Westerns to give the patient who was bored. I did spend 15 min calling up that other patient and explaining oxygen and another 15 min talking to a different patient’s family member and another 15 min calling a doctor to get a fourth opinion that didn’t change anything but just to check and another 15 min to make sure the night doctor knew about a complex family situation and another 15 min prepping a discharge for a patient that wasn’t even mine that day so we could free up a needed bed more quickly and help them get home sooner and another 15 min leaving a couple extra suggestions in my notes for the next doctor after me who isn’t as experienced with Covid care and make sure they know it’s ok to call me with questions even on my day off and another 15 minutes calling a pharmacy to check if they have OTC medical supplies to help the texter and just another 5 min checking that the resident on the ICU team responding to that emergency earlier was doing ok and didn’t need help.

And so I miss dinner time with the family and bed time with the kids and now the morning after am sitting up in bed writing this instead of playing with my kids because I woke up and cried into my pillow a little because I realized how hard changing how I care is going to be because I just don’t know how to do it or at least not without feeling like I’m giving up a part of myself. And I think about all the colleagues and friends who talked/texted/commented/shared that they are struggling with compassion fatigue too. And I tell myself I do care.

And I do.

I wrote this for you.

And for everyone else reading this, know that however much we grumble and vent, we still care. It hurts us more not too. We just don’t know how to do it in a way where nobody gets hurt. Can you help us with that? Can you care for us too?

* Cases may have been amalgamated over time to protect identity, though the occurrences are sadly common.

Post-Script:

Saying “I shouldn’t care about…” is harsher than how I actually feel, which is more akin to “I shouldn’t feel obligated to…” but I am emotionally wired to feel and think of caring = obligation. Yes, that’s a pre-Covid attitude that has needed work to change, but everything just feels more intense and more difficult these days. My writing is meant to be transparent to that struggle in establishing a new emotional equilibrium which, I suspect, many feel the need to do even if without really knowing how.