Compassion fatigue

“You do care,” said Dumbledore. He had not flinched or made a single move to stop Harry demolishing his office. His expression was calm, almost detached. “You care so much you feel as though you will bleed to death with the pain of it.”

JK Rowling “Harry Potter and the Order of the Pheonix”

Somewhere inside my head a slight floodgate opened last week at the mention of the phrase “compassion fatigue” at an appointment. It’s a term I am familiar with, but never applied to myself. It came up in conjunction with talking about the fear, akin to terror, that comes with the thought of returning to work in the caring profession, an area I love, the only thing I am really trained to do, the only thing I ever wanted to do. All my life it was never “my job”. It was “what I do”.

Not anymore.

The fear stops me from even keeping in touch with the people I supported. This leads to intense sadness and guilt and then to shame. I never really quite understood where any of this came from. The way that I was “let go” from the job I had loved for 20 years was not what I expected. For a long time afterwards I was left with a sense of having done something wrong. I even referred to it as “being fired” a few times and when corrected, pointed out that that is what it felt like. Then I realised that my feelings were not really about the termination of employment and more about what led up to it. It was only though stepping back that I could look back and see the patterns.

Compassion fatigue, also known as vicarious trauma, is described as an overuse of empathy and a sense of failure when the service user or situation is not improving. Jennifer Reidy of Compassion Fatigue Ireland (http://www.compassionfatigueireland.com/) feels that,as a result of the challenges of a caring role, whether paid or unpaid, levels of PTSD, Burnout and secondary trauma are significantly high and that everyone in a caring role needs access to the training and information that could prevent the problem developing before it leads to breakdown or job loss.

In the years leading up to going on long term sick leave, I was often laughed at (not in a bad way) affectionately for my habit of coming into work early. This went from half an hour early, pretty normal, to an hour, then two hours, sometimes more. No one ever asked me why. I don’t think I would have been able to reply. Our workload was immense and it seemed to me that starting early helped to manage my own stress levels and to be more present for the people I was caring for.

Looking back, I also see that while waiting to go on shift, my anxiety rose to such an extent that it was easier to actually be at work than to be at home worrying about it. Even typing these words is sending my heart rate higher and higher. That sense of stress had become very normal. Shift work was very normal to me. It wasn’t until I was off sick that I realised how exhausted I was. I had stopped taking holidays…only using my annual leave for a day or two here and there when the exhaustion was too much. I hadn’t slept properly for years. It seems strange to me that any workplace that employs people to do shift work wouldn’t fully recognise that it takes its toll. When I asked my employers to let me move to day hours, the only option they gave me was more shift work but at a lower grade. This proved impossible for me so they gave me six months unpaid leave but after this, it was still impossible to return to work and the options ran out.

Unfortunately, denial is one of the symptoms of compassion fatigue and that works to prevent people from recognising what is happening to them. I was also struggling with mental health difficulties and so it was very difficult to separate out what was happening. I had been a carer at work for 20 years. I had been a carer at home. Neither role had, I thought, caused me any personal difficulty and I loved my work. I couldn’t figure out why this would change. Yet, the dread of going in got worse and worse. There was a sense of failure, fear that some nameless, terrible thing was going to happen and I wouldn’t be able to protect the service users from it. I worried constantly.

It surprises me that a lot of the symptoms are still with me. I worry so much about causing harm to people I care about. My impulse in most situations is to take responsibility and that hasn’t changed but the dread comes with it. Even in my voluntary work with rescue animals, there are times when I feel the tell-tale fear and the sense of literally holding lives in my two hands. There’s the shame and guilt that hammers into me about the people I cared for at work. I love them dearly. I dream about them, think about them and feel such shame for not being what I wanted to be for them, for having ultimately failed, as I used to worry so often about.

The thought of walking back into a caring role makes me feel physically ill with fear. Yet, I think about various projects at work and the areas I was most interested in and the enthusiasm is still there. It’s a strange inner conflict.

For anyone reading this in a caring role, please look up compassion fatigue and burnout and see what your workplace or support systems can do to help you stay clear of it. If you recognise yourself in the descriptions, get help now rather than later. Empathy is a great gift but unfortunately it’s a fragile one. Sadly the people prone to burnout are also the people that are needed in the caring profession so it’s important to get the balance.

And for those I have let down, both inside and out of my job, I am truly sorry and I love you all… my caring might be all at a physical distance now. But it is still there. The more the numbness gradually fades, the feelings start to emerge, sometimes good, sometimes painful. But they are there.

“for there is nothing heavier than compassion. Not even one’s own pain weighs so heavy as the pain one feels with someone, for someone, a pain intensified by the imagination and prolonged by a hundred echoes.”

― Milan Kundera, The Unbearable Lightness of Being