Two weeks ago, I felt joyful and engaged and energetic all week at work—and profoundly, staggeringly exhausted that Friday evening, when I had a burrito with F. at Taqueria San Jose. It was a lesson in how compassion fatigue might sneak up on a person. It might be an inch away before one realizes it is there at all. The following night, I had dinner at Old Jerusalem with Lisa and David, visiting from Seattle, and two other folks. It was great to see David and Lisa.
At work, I’ve been getting very good results by observing the patient I’m visiting, identifying what emotion his or her facial expression most nearly suggests, and asking, “Are you a bit [whatever emotion]? Am I reading that correctly?” Eight times out of ten, the patient says, “Yes, I am,” and tells me more about it. One patient who prides himself on being inscrutable said, of my being able to detect that he was sad, “You scared the shit out of me!”
Another thing that can be quite powerful is to mentally count to three after a patient stops talking and before I say anything else. Nearly every time I do this, the patient starts talking again, and this is presumably something he or she really wants to say, since it’s not in response to anything I have just said, or to my asking a question.
Along with our statements of service, we had to produce a creative work of some kind. I really liked this, because it allowed me to spend several days thinking of the various things I might do, after quickly ruling out performing an interpretive dance: shall I write a haiku? Paint a painting? Draw a drawing? Drag the keyboard out of the closet and compose a tune? Do something involving my photographs? I thought it was wise of our teachers to make this assignment, because creativity is a potential source of joy and self-nurturing as this work deepens (or at least continues), and perhaps a good way to address compassion fatigue, which I learned in the Sati Center program is inevitable: if you stand near a bonfire, your clothes will smell like smoke, and if you’re around a lot of suffering, you will experience compassion fatigue.
I remember one day during my summer unit of clinical pastoral education reporting that I was having trouble sleeping. One of the staff chaplains said difficulty sleeping can be a symptom of compassion fatigue, which he said you can indeed have after just eight weeks of CPE (as was true for me at the time). He said we need to remember to do the things that bring us joy, such as hobbies we might have let fall by the wayside. He said people confuse compassion fatigue with burnout, but they’re not the same. Compassion fatigue comes from dealing with all the emotions that arise in caring for dying or ill people—our cup is overfull with feelings. Burnout is more when we hate the whole system, hate our boss, etc.
I asked if there’s such a thing as being a hospital chaplain without being stressed out and he said that in itself, it doesn’t have to be an overwhelming job. He said he’s gotten to the point where his job per se doesn’t unduly burden him, but he said it’s not a simple, mindless job, and it will always be challenging. When you add in running a household, raising kids, and all the other things we do (such as putting gel on the ear of a cat), there is the potential for stress.
Another thing we have to watch out for is allying with a patient against one of the staff or a family member, a la the “Drama Triangle” or Karpman Triangle, in which there is a victim, a persecutor, and a rescuer. The chaplain is prone to leaping into the role of rescuer, but needs to remember to check his or her assumptions: Is the patient’s father really a jerk? Are the nurses truly mistreating the patient? Perhaps so, but the chaplain should inquire further: “What has happened that makes you feel this way?”
It’s mild, as problems go, but I’m finding that one of the most challenging parts of the day is when I arrive at work and am with seven or eight other codependent “helpers” in one small room. Part of it is just accommodating everyone’s need to stow his or her stuff, change his or her shoes, get some tea, and maybe use the one (yep) computer we all share. The choreography is complicated. At the beginning of the unit, I noticed how people’s anxiety levels would rise and fall, and how palpably that could be felt in the room. Now we are past the orientation phase and there is much less anxiety, plus I think that many (though not all!) of us have figured out that it’s best to try to keep things quiet and low-key in the morning.
In my second verbatim of the unit, I wrote about a visit where I left the room when I thought the patient had had enough of delving into emotions for one day (the one who said I scared the shit out of him). Our discussion made clear that more likely it was I who had had enough, or, at any rate, that I should have checked my assumption by asking the patient explicitly if he would like to continue talking. When I said that I need to be at the top of my game when it comes to self-awareness, I guess I should have added that my top game is probably like other people’s not-top game. I felt discouraged after discussing this verbatim—am I an emotional cripple?—but remembered what Samantha said during the summer: we can do good work while doing our own work. I shared that with Jodie in our weekly meeting, and she enthusiastically agreed.
After three weeks of feeling very purposeful and even buoyant, there was a day this past week when my attitude was noticeably more downbeat. I found myself starting to worry about money. One of my peers has a spouse who is a software engineer (“That allows me to be a chaplain,” she said) and another is married to a doctor. I am lacking a software engineer or doctor spouse, but I do have savings, and I’ve also had enough of worrying about the future. I did that all summer, and it was not fun. This is what I’m doing, and I find it to be profoundly meaningful, so I’m going to keep thundering down this path, as a colleague at my former job once said, until I hit an unmistakable dead end.
I suppose no mood of any kind can last forever, and I also think I was starting to feel the strain of thinking I have to be happy and nice all the time—which are not things any CPE supervisor would ever instruct anyone to do. I don’t have to be happy or nice. I have to be present, and this I can do. It was also a day when, for one reason or another, I did not see a single patient the whole day. The next day, I saw a lot of them, and felt happier.
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