Keith Espenshade

From Keith Espenshade, LG Health Chaplain

Compassion fatigue is a risk for anyone in a helping profession.

“Sometimes listening to the pain and suffering of others can cause us to close off our hearts. And a closed heart can’t love as fully or listen as deeply as an open heart,” Mark Brady writes in “Right Listening.” 

Meaningfulness and purpose in work are essential. When we do not see results from our work, we can start to question whether our work is serving any real purpose. Burnout will happen quickly when work seems meaningless. In fact, one way to break the human spirit is to assign a person a task that is completely meaningless and without any purpose. For example, endlessly moving a pile of dirt from point A to point B and back to point A would take all the joy out of work for most people.

When we work with people, it is often difficult to gauge our effectiveness or the impact of our work in a meaningful way. Counting the number of patients seen is seldom a measure of meaningfulness. There are times when we see a patient, diagnose the problem and significantly improve that person’s life. Those moments are wonderful. There are also times when we see a patient repeatedly who continues to struggle with the same problems. And then there are all the associated tasks that eat away at meaning. Paperwork, billing codes and insurance authorizations were not the driving factors for anyone to enter medical school.

What is it that gives meaning to your work? What is the purpose of your work? Do you have ways to know if you are achieving your purpose?

“Compassion is hard because it requires the inner disposition to go with others to places where they are weak, vulnerable, lonely and broken,” writes Henri Nouwen, psychology and spirituality professor, priest and author. Who in their right mind chooses to spend most of the time with people who are sick, injured and anxious?

The times that I have experienced the least job satisfaction were when I felt I had no choice. I felt stuck in a bad situation and powerless to make any change. A key part of complaining is that it comes from a passive and powerless perspective. The reality is we do have choices. Some choices are quickly ruled out since we do not like the consequences, but it is still a choice. Sometimes, however, we have more power and more choice than we realize. We can address systemic issues and change aspects of our work. When you catch yourself complaining, take a moment to think about what you really want, then see if there is any step you can take to move toward what you really want. Other times we can’t change the system. There is great wisdom in knowing when to try to change reality and when to focus on coping with reality.

Recognizing choice does change our perspective. I feel different if I focus on “I am choosing to do this even though it is difficult” rather than giving in to the trap of “I have no choice. I simply have to do this.”

Keeping perspective in life makes a huge difference. We can all make ourselves feel worse by telling ourselves how bad we have it. I remember feeling sleep-deprived in anticipation of 48-hour call shifts during my residency. The anticipation of what might happen impacted me regardless of how busy the shift actually ended up being.

What is the worst profession for stress? Who has the toughest job? Who is the most underappreciated? At times I think many people in many different professions think they have it the worst. “Nobody really understands what we do. … There is always pressure to do more. … Do more with less... I’m pushed beyond my limits, but no one cuts me any slack if I make a mistake. …” I have heard such comments from physicians, nurses, teachers, environmental service workers, mechanics, and yes, even from chaplains. While practicing medicine involves some unique stresses, burnout is prevalent for many professions. What things do you tell yourself that add to your level of stress?

One method for keeping perspective is intentional gratitude. Look for and identify things for which you are grateful. They may be small things, such as a smile, a thank-you, someone holding the door for you or a pleasant, sunny day; or they may be big things, such as having someone point out a potential error graciously, making a positive impact on someone’s life or feeling a sense of community with one’s co-workers. What are you grateful for today?

So we have chosen to be in professions that involve significant stress. We choose to spend significant time with those who are sick, injured, hurting and afraid. What small changes can you make in your perspective that will help to boost your immunity to compassion fatigue or even burnout? I would love to hear what you discover.

Keith Espenshade is a board-certified Clinical Pastoral Education Supervisor and has trained interns and residents in spiritual care at Lancaster General Hospital since 1998. He is the director of the James & Sally Saxton Chaplain Fellowship in Oncology and co-chair of LGH Biomedical Ethics Committee. He is also a certified trainer and master coder with SAVI® (System for Analyzing Verbal Interactions®). Readers may contact him with any questions or comments.

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