The G Spot: Compassion

The purpose of human life is to serve, and to show compassion and the will to help others. – Albert Schweitzer

On the list of attributes that you would prefer in a physician, compassion is definitely on the top of the list. Although intuitive that all health care physicians are compassionate, it’s far more complex balancing compassion while keeping negative emotions out of the practice of medicine. You want a physician who is sympathetic, but not too empathetic. If your doctor is very empathetic and gives you the news that you have cancer while he cries uncontrollably, you will probably Google “doctors who don’t suck” while he tries to compose himself. On the other hand, if Dr. House is giving you the news in a snarky, derisive tone, you will probably contemplate throat-punching him.

I will warn you that some of this column might be hard to read, especially if you are struggling with the death of a loved one. In liberal speak, this may trigger you.

When I was a new emergency medical technician in the emergency department, I found myself hoping that I would see something dramatic. This is a position that every medical professional in training has felt at some point, inevitably followed by a feeling of guilt. It is not that we want bad things to happen; we just want to be there when they do. The first person who died in front of me was a 54-year-old man who had a heart attack. He went into cardiac arrest in front of us and I performed chest compressions for 25 minutes. I was in great shape back then! When we stopped attempting resuscitation, I stood there exhilarated, exhausted, drenched in sweat staring at a lifeless body that recently housed a talking human being. Witnessing a life extinguish is a humbling and surreal experience.

Weeks later, I found myself in the trauma room awaiting the arrival of a man with a gunshot wound to his chest. He thought it would be a good idea to try to run over a Los Angeles police officer with his car. This was the perfect combination of a gory trauma and a “bad guy” that you don’t really feel sorry for. While in the trauma room, he lost his pulses and I had a ringside seat while the emergency physicians cut open his chest and massaged his heart. It was the most amazing thing I had ever seen. When he was eventually pronounced dead, I found myself again staring at a body that previously housed a living person, although it is much easier when having the opportunity to blame someone for their situation.

In medical school and residency, I trained at a busy trauma center. I saw many people whose choices to ride a motorcycle without a helmet ended up in cognitive function that rivaled a goldfish. It’s easier when you get to blame the victim even though the tragedy remains. I remember a 15-year-old girl whose car was hit by a car that fell from an overpass onto the top of her vehicle. As she was improving in the ICU, she died unexpectedly one night. Another patient was a very sweet 16-year-old who was at home while her parents were out buying a car for her as a surprise. While she was home, someone invaded her home, shot her, and she played dead while he stole her jacket off of her body. By the time her parents arrived, she was paralyzed from the bullet and would never drive that car.

In my years in medicine, I have seen babies, children, mothers, fathers, grandparents, and great-grandparents die. I have given the death notification to families hundreds of time; to children who were then without a parent, to adults who lost a child too early, to a conference room full of 30 family members rallying around their loved one. I pronounced my flight instructor – a great man and great teacher – dead after hours earlier I was talking about how he made me a good pilot. I spent hours trying to save a 3-year-old girl unsuccessfully, and not a week goes by that I don’t think about her.

As a family medicine physician, I had one patient who has haunted me for more than a decade. She was 37 years old when she finally convinced me to prescribe her opioid pain medications for her chronic pain. I resisted for 6 months before I finally gave in, as she did everything expected of her, and convinced me how disabling her pain was. I prescribed her a fairly low dose opioid pain medication while telling her that she was probably better off without it, and telling her that people can die from those medications even when taken as directed. Two weeks later she was dead from the medication that I prescribed. Although my practice was well within the standard of care, my overdose of compassion exceeded my instincts that this would be harmful.

Over the last 13 years, I have worked most often night shifts in the emergency department. On an almost daily basis, I have a patient who is angry or upset because I did not give them the medication that they wanted. It is my job to protect patients from themselves, and I put their safety ahead of their patient satisfaction. I get yelled at and called every name you can imagine (I think my favorite scribe might be compiling a list for her amusement). I am often threatened, and I’m periodically assaulted. We deal with violent patients who try to assault us regularly, and in fact, my torn rotator cuff that will get surgery next month was a prior injury exacerbated while restraining a violent patient. It is hard to remain compassionate while being called an ass-clown and having patients trying to kick you in the head. Is ass-clown supposed to be hyphenated?

A few years ago, before Dr. Craig was giving free therapy to Doni’s loyal readers, I was a patient of his. I started the visit by explaining to him that I was concerned that I was becoming too much of an asshole. Dr. Craig is a very intelligent man with an excellent sense of humor who smirked a little bit over my brutal honesty. As I started telling him stories of the regular conflict that I endure in the emergency department, a mild look of shock on his face revealed that he and I certainly deal with a different patient population. Perhaps he was being a good therapist validating my emotions, but he appeared to be stunned by the constant traumatic experiences that I endure at work, and seemed surprised that I wasn’t more cynical. I vowed to try to exercise more compassion and not let the negative experiences erase my humanity. I was true to my word and found myself being a better doctor.

In the emergency department literature, there is a lot of discussion of physician burnout, and one of the signs is compassion fatigue. It is easy to start seeing our patients as the enemy and walk into each room ready for a fight. There is a lot of discussion currently about the high rate of suicide seen among emergency physicians as our field has lost quite a few physicians over the last couple of years. Don’t worry, you don’t need to talk me off the ledge.

I am constantly battling compassion fatigue as I try to do what is right for patients. I regularly have patients storm out telling me what a horrible doctor I am for not giving them Norco or Dilaudid or Xanax. My recent work in addiction medicine has added another layer of humanity to me as I have learned that these “junkies” or “drug seekers” are people going through the worst battles of their lives. Many of them are good people whose families are struggling to help them while they are trying to figure out how to help themselves. A “junkie with an abscess” has transformed into a person who needs help and perhaps my 10 minutes talking with them with sympathy and without judgement will be the moment that changes their lives. I’ve seen it happen, and it is amazing when it works.

The reason that I wrote my first article is that I see our community and our society is suffering from compassion fatigue. Plastered all over Facebook are judgmental comments and blame while I see a paucity of sympathy. We see homeless people and drug addicts overwhelming our town. We blame them for their problems and then dismiss their horrific existence as a choice, as if any person would choose the inhumane conditions in which they exist. We see acts of humanity as people give to panhandlers in a misguided attempt to help. We see people trying to help the homeless, and even outsiders making them floral arrangements. As we see in politics, Redding seems to be divided between those who want to help the unfortunate and those who want to find a distant land or bigger jail for them.

As a community, we appear to be getting more heartless to the suffering that surrounds us all. Since we cannot help them, we blame them. If we become too empathetic our efforts at helping may transform to enabling and inadvertently harming. Just like my efforts as a physician to find balance, so must we as a community. We need to recognize our pathologic thoughts and behaviors and retain the humanity that is within all of us. It is incumbent upon us to recapture our humanity and help those in our community who need it.

Greg Greenberg
Greg Greenberg grew up in Santa Monica, California. After undergraduate training at UCLA he attended medical school at Ohio State University and completed a residency in family medicine in Columbus, Ohio. He moved to Redding after residency in 2004 and has served the Redding community as a family physician, hospitalist, emergency physician, and, most recently, in addiction medicine. When he’s not enjoying the calm atmosphere of the emergency department he enjoys the chaos of being a full-time parent as well.
Comment Policy: We welcome your comments, with some caveats: Please keep your comments positive and civilized. If your comment is critical, please make it constructive. If your comment is rude, we will delete it. If you are constantly negative or a general pest, troll, or hater, we will ban you from the site forever. The definition of terms is left solely up to us. Comments are disabled on articles older than 90 days. Thank you. Carry on.

18 Responses

  1. Randall R Smith says:

    Early in the AIDS epidemic a wise surgeon from San Francisco came to Redding to lecture about those who were choosing which patients to serve.  He opined that treating all comers or withdrawing from the field were equally moral.  Eventually, his opinion saved me by allowing withdrawal when the well of compassion was exhausted.

    • Greg Greenberg Greg Greenberg says:

      It’s difficult not to get burnt out.  It is also brave to recognize when you’re not doing what’s best for your patients and take time off or do something different.  I applaud you for making a difficult choice.

  2. hollynchase says:

    Thank you Dr. Greenberg. As usual, your words are readable, thoughtful and true.

     

  3. Richard Christoph says:

    Thank you, Dr. Greenberg, for candidly sharing your experiences in such a sensitive, compassionate, and poignant way.

  4. Beverly Stafford says:

    Pharmacists, too, are on the receiving end of angry patients over opioids.  They are accused of shorting the medication that was prescribed.  Explaining that the doctor’s instructions were to count the pills twice before dispensing does little to ease the situation.

    Thanks, Dr. Greenberg, for another thought-provoking column.

    • Greg Greenberg Greg Greenberg says:

      Good point Beverly.  My friend Christy is on the NoRXAbuse committee with me and she often declines to fill dangerous combinations of medications and then experiences the wrath of patients and physicians.  I don’t envy that job.

  5. Gil says:

    Fascinating and painfully articulated ….yet balanced with such compassion and depth. Thank you Dr. G.

  6. I love the way you tackle such weighty topics with humor,  fact, and yes, compassion. It’s a rare writer who can bring readers to tears and laughter, sometimes in the same paragraph.

    Thank you for your column, The G Spot. It’s spot on.

  7. Tom O'Mara says:

    Good perspective for all of us patients to have.

  8. Carrie Dokter says:

    Thoroughly enjoyed reading about your interesting experiences. A thought provoking eye opener!

  9. Barbara Stone says:

    I, too, am amazed at how uncompassionate that we as a society have become.

    I know for myself, when I see a “street person”, I go through an array of emotions which include fear, sorrow, disgust, and then I try to analyze what would be the best way to help them…if it is even possible to help them. How does one help an addict or a mentally ill person? Do they even want help? Why do I think I can help them?

    And so it goes.

    Thanks for sharing your pov.

     

     

    • Greg Greenberg Greg Greenberg says:

      Barbara, I struggle with the same thing.  There is so much suffering in the world, empathy takes its toll.  I periodically joke that I lose a little bit of my soul every night shift I work in the emergency department.  I often use the words “junkie” or “tweaker” despite just attending an addiction medicine conference (next week’s article) where we were told that such terms are derogatory and should not be used.

      I have worked extensively with the homeless and you can’t put them all into one category.  Some are mean and really not nice.  Some are kind and long for some understanding.  I believe in personal responsibility and we can’t help those that don’t want help.  There are many who do want help which is why I think as a society we need to have mental health and addiction treatment for those who want it.

      Giving money to the homeless may be an act of compassion but I think is more harmful than helpful.  Encouraging services to feed and house the homeless is more likely to be helpful without enabling them.  Instead of looking away in disgust, smile and say “Hi”.  I do that and a simple gesture of kindness may help restore their humanity.

  10. K. Beck says:

    Thank you Dr. Greenberg. Well said!

    Stanford University offers a FREE online class (sign up for their e-m list of offerings here: https://www.class-central.com/university/stanford) called America’s Poverty Course (https://www.class-central.com/mooc/7992/stanford-openedx-america-s-poverty-course). As someone who grew up in the USA in a lower middle class family, I thought I understood the whole living in poverty experience. I did not. I only knew MY situation. Really that is all anyone knows, their own situation. No one else is you. And you are no one else! There are so many aspects to poverty in this country it is mind boggling. I recommend this class to everyone. EVERYone! You don’t even need to purchase the text book. And if you do want the text book, you can rent it from Amazon.

    If you want to hear a discussion about “unearned privilege” go here: https://www.facebook.com/brenebrown/?hc_ref=ARSMp9Pjbv9n_Bgxf5ep0Ncmkjeg5tdfE14yn-blho7Rvw-IlooSRszYct100lKRjqU, scroll down to 15 AUG, look for the title: “We need to keep talking about Charlottesville,”about 30 min. Warning: there is profanity.

    Dr. Brown calls it a “lens.” Dr. Grusky calls it a “bubble.” No matter what it is called, it is the sphere we live in and we have no idea what other people’s sphere is like.

    As an aside, I once spent a whole week flat on my back in bed because I damaged my lower back (thanks to a somewhat less than knowledgable aerobics instructor). I was able to go back to work after that week in bed, but I was in pain every minute of the day. My Internist, finally, after many calls to her office, recommended Physical Therapy. It worked! However, I have to say, I could not function being in pain 24/7. I would have been begging for some pill I could pop to make it go away. Eventually I would have lost my job because you cannot think when you are in pain. I was my only source of support. I would have ended up on the street. So, I understand how people could get angry with a Physician who refused the pill. Just another perspective to consider.

    • Greg Greenberg Greg Greenberg says:

      Thank you for sharing your experience.  I try to remember that many of the patients who lash out are in pain, scared, and really don’t want to be there.  And some are just mean.

  11. Joanne Lobeski Snyder says:

    Thank you for an extraordinary article Dr. Greenberg.   I am grateful that I’ve seldom experienced any pain that required pain medication, and I’ve refused offers of pain meds for manageable pain.   A friend told me a  “wake up” call story  about filling her prescription after a back surgery.  She’s a professional woman.  The meds at the pharmacy weren’t ready when she went to pick them up.  The prescription had been sent to the wrong pharmacy.  She yelled at the woman behind the counter and stormed out of the store.  By the time she had driven to the pharmacy where her prescription was, she realized that she had a problem.  She weaned herself off the med and returned to the first pharmacy to apologize to the woman she had berated.  That woman was so surprised by the apology and said it wasn’t the first time someone had shouted at her.

    It’s a such a complex issue.  We have to be responsible for our health and work in concert with  good physicians to maintain that health.  My friends who have died from opioid addiction “were following  Dr.’s orders.”  Not

    Again, thank you for an intense perspective for your world.

  12. Cruzer says:

    A comment, intended only for one reason. That one reason is; for the benefit and comfort of all. To accomplish that this comment has to be free of any personal immature pre conceived views or judgments on my part.
    This comment is the undesired conclusion of 17 long, miserable years (and still enduring) concerning this very vital topic of opioid use by humans.
    Therefore here is the truth that all have to deal with every day whether you prescribe opiods or consume them and anyone in between them such as pharmacist, asissants, ect.
    One must have an accurate view of the illness before treatment, don’t you agree?
    So, if we start to treat this “opiod illness” on our own without an accurate view of the entire problem, we are just treating a symptom, wouldn’t you agree?
    And that, is all I’m seeing from all who are involved! No wonder indeed, their is such a problem.
    It’s always been my view that any good doctor absolutely has to get to the root of the cause of the illness, then prescribe proper treatment.
    Unfortunately that’s not the what happens when one goes to the doctor for health care.
    It’s only the symptom that is treated. To illustrate, a patient with “high blood pressure is prescribed
    a chemical compound to lower it, correct? So that doctor has treated the symptom, not the cause of the so called “high blood pressure. So patient leaves doctors office content that all is well, doctor is content with following proper guidlines to treat patient as per status quo, therefore all is just ducky with doctor, staff, pharmacy, pharmacist, patient and family.
    Not so fast, only the symtom was treated, not the cause, if there is a cause in the first place!
    I understand that in other countries, its low blood pressure that is most commonly treated.
    The point, simply, is this; patient is now consuming a chemical that physiologically altered the natural and properly designed chemical processes in the human mind that will not help the cause nor extend his life.
    This is what I see happening in the opiod crisis.
    “Symptoms” of addicts, symptoms of doctors who rightly prescribe, but patient dies of overdose blame themselves and having to live with that uneccessary burden (and their families) for the rest of their life, though no fault of their own and so many other pressure’s like the FDA ect, ect. Symptoms of broken hearted families who lost a precious loved one left confused and wondering, why, why? Not finding a satisfactory answer, blame themselves just like the doctor, symptoms of homelessness, themselves and those who observe them (public, families, ect) not sure of how to deal with each other, resulting in unsolveable problems, symptoms of those who have symptoms of chronic pain, in order to live with that kind of suffering, half to rely on a toxic, mind altering, highly addictive chemical that causes all kinds of problems, yet its the only thing that works on their pain, must I go on?
    You see, as tragic as these are, they are the symptoms of a disease whereas the root cause is the problem. Once that is i’d and properly treated, then these symptoms disappear, correct doctor?
    So, here goes, what is the root cause of this opiod crisis?
    The answer, with great fear and trembling on my part so don’t want to offend anyone, is ahem,

    Big Pharma. Aka, corperate greed. In one word, the answer is simply this, one of mankinds greatest weaknesses, Greed.
    Ok, I know, that’s a bit much for most plus, how you going to treat that?
    No I am not, repeat not advocating revolution or anything remotely close to that, no. Never, ever works, even if accomplished more of the same would take over anyway.
    Yet there are things that can be done on an individual basis, each one with his burden can do much to lower, possibly leave those burdens or symptoms, permantly behind for the most part for themselves as well as others, so cheer up! The rest of this is all positive from here, but first, we had to identify that wily coyote in order to properly move on.
    More on that if requested.
    Thank you.

    • Greg Greenberg Greg Greenberg says:

      Cruzer, I appreciate your comments. I will have a future article discussing specifically the history of opioids and how we got where we are and another discussing treatment. It is, without a doubt, that the influence of pharmaceutical companies contributed heavily to the opioid epidemic. It is unconscionable that the medical system allowed this to happen. Now that I’m actively working in addiction medicine, it is clear all of the harm that has been calm.

      You can’t distill it down to just one thing. We know that adverse childhood experiences correlate directly to the risk of addiction. Often we are trying to medicate the pain of life and that just doesn’t work. We are messing with the powerful reward system in the brain that is very hard to overcome.

      There are many of us who are working to help get this problem under control. My article next week will discuss my experience at an addiction medicine conference. Another future article will discuss the NoRXAbuse multidisciplinary committee that I’m on. This topic is actually what inspired my column. My goal is to educate and hopefully entertain readers a little on the way.

  13. Common Sense says:

    Another excellent article! Perhaps Tylenol is one of the causes of lack of empathy and compassion?

    http://www.npr.org/2016/07/06/484894653/researchers-examine-why-tylenol-affects-empathy

    With nearly a quarter of adults using it….mmmm

Leave a Reply

Your email address will not be published. Required fields are marked *