Monday, October 22, 2007

Compassion Fatigue, Monday Style

Today was the first Monday since I made the decision that a leave of absence is in the cards and coming soon. That said, my morning behaved in a way which underscored my need for a break and the "compassion fatigue" that has settled into my bones.

My first patient of the day was a 10am home visit to someone who lives in the subsidized housing near the clinic. I strolled through the lovely autumn morning and rang the bell, riding the rickety elevator to the third floor. My patient hangs out at a local community center, drinks what I fear is far too many beers on the weekends, and has personal hygiene which leaves much to be desired. Just last month, I visited and checked through her medications, noting that most of the prescriptions were dated from June of this year and had not been refilled since. Just to be sure, I called her pharmacy, and lo and behold, she has not filled a prescription in five months. With asthma, hypertension, high cholesterol, and a host of other chronic conditions, some of these medications are crucial to her well-being and survival.

"So," I began, "I see you haven't been taking your medications."

"Oh yes," she responded. "I take them every day like you taught me."

I shake my head. "Now, how can that be?" I ask, "when all of these prescriptions were filled in June and you haven't been back to the pharmacy since?"

She was speechless, stammered an excuse, and looked away.

"Look," I said. "These medications are not for my health, they're for yours. Either take them or not, but don't tell me what you think I want to hear. Tell me the truth."

"I'll start taking them all tomorrow, I promise," she said, putting out her hand for me to shake.

"We can shake," I said, "but I don't believe you today. We've done this before. See you next month."

"I love you," she said as I left her apartment, one of the few English phrases she knows.

I returned to the office, feeling angry that my months of work with her had done so little to effect her consciousness vis-a-vis her health. I drank a cup of coffee and went out to the waiting room to assess a patient who came in to see me without an appointment.

"I'm so anxious and depressed," she said with tears in her eyes. "I have chest pain, neck pain, back pain, a rash on my face, and my eyes feel hot. Also, I'm constipated, I'm nauseous, and I'm losing weight because I have no appetite. And the veins in my hands feel hot." She grabbed my hand as if to demonstrate the feverish heat of her fingers, which actually felt cool to the touch. Her husband sat on the exam table watching our interaction gravely as she enumerated her myriad symptoms.

Leaving the exam room, I went back to the office briefly, sat down, and literally lay my head on the desk, despairing over the fact that I had nothing to say to this tearful woman amidst her calamity of medical symptoms. Gathering my wits, I returned to the exam room, offered some supportive counseling, secured her an afternoon appointment with her doctor, and sent her home to rest for a few hours.

Did someone say compassion fatigue? This Monday morning onslaught of unresolvable circumstances in the face of multiple chronic illnesses and exhausted apathy seemed to wear on my soul like a grindstone. It was a day when my ability to be annoyed or have my patience worn thin was as raw as I could imagine it to be. (How may days until that leave of absence?)

Patience worn thin
compassion meter maladjusted,
crispy nurse lurches
towards rest
for the weary caregiver's soul.
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