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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.