In August, my mother was unexpectedly hospitalized. Following two major surgeries and a long hospitalization, she passed away from heart failure in December. During her hospitalization in August and the long autumn of recovery, I had the opportunity to experience palliative care first hand, and later, in December, the blessing of Hospice, which provided the support for me to care for my mother at home, the place she most wanted to be.
Over a 30+ year career in healthcare, I have witnessed a lot of illness and death. At times, there is an absurd juxtaposition of living and dying in the same space, and I am reminded of a time I stood at the bedside of a patient in ICU with a tennis match blaring on one of the TVs while a code took place at another patient’s bedside. In the fast moving world of healthcare, one family grieves, while another celebrates a medical win or respite from a serious illness. We eventually experience the loss of our own parents or other family members, and, after a few days off work for a funeral, containing our grief, we return to work “staying busy,” which we are told is good for us.
We all know that death is an inevitable part of life, and as often as we experience it as healthcare providers, it seems sometimes that we are immune to the associated grief. We spend so much of our time helping patients “battle”, “conquer”, and “wage war” against illness and disease, that when the” battle” is lost, we are sometimes left with the unexpected response of grief.
Yesterday, I heard from the daughter of a patient of mine, that he had passed away. Jim was an active member of my weekly speech class, The LOUD Crowd, and recently, he had reluctantly left Florida and re-located back to his original home in Cleveland, due to a decline in his health. When I hung up the phone with his daughter, I sobbed, and this morning, on an unusually rainy Florida morning, I find that I’m still crying. This morning, the grief seems cumulative, my mom, my friend who passed away this summer, a patient. It should be obvious that eventually, personal experiences of loss coupled with loss of patients wears us down or leads to what some have termed: “compassion fatigue.”
A consequence of caring for suffering patients is the development of compassion fatigue, which has been described as the “awareness of the suffering of another coupled with the wish to relieve it.” When healthcare providers show compassion while caring for patients on a daily basis, a state of exhaustion often described as “running on empty,” or compassion fatigue, may result.
Most of what has been written on this topic has been directed towards nurses, but I would say that any of us, including speech-language pathologists, who work with patients daily, including individuals with chronic, neurodegenerative disease diagnosis, need a bit of self-care. We are so accustom to counseling patients about what THEY need to do, that we are not always as attentive to our own needs.
So a few suggestions I will share and try to undertake myself:
- Establish a method of shedding the professional role at the end of the day, which might include not reading emails after a certain time in the evening.
- Engage in activities that replenish, comfort, and renew the spirit.
- If inclined, set aside time for spiritual practices such as meditation, prayer, or journaling.
- Engage in exercise, or meditative practices such as tai chi, or yoga
- Talk to a professional, if needed
It has become apparent to me, not only from my own experience, but from some of the questions and comments I read on a professional discussion board, that end of life education for all healthcare professionals is needed. Not only do we need to know what services are available for sick and dying patients, but what is also needed are communication skills that might help speech-language pathologists, like nurses, learn how to handle conversations with patients and families who are ill or may be suffering. We also need to recognize when we might need support.
Perhaps this post will lead to some discussion. I would love to hear from you.
Ref: Radley, F., & Figley, C. (2007). The social psychology of compassion. Clinical Social Work Journal, 35, 207–214. doi:10.1007/s10615-007-0087-3 Boyle, D.A. (2011). Countering compassion fatigue: A requisite nursing agenda. Online Journal of Issues in Nursing, 16(1), 2. Clinical Journal of Oncology Nursing • Volume 18, Number 4 • Coping With Grief and Compassion Fatigue
To enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate and empower.
Mary Spremulli, MA, CCC-SLP
Thank you for your warm thoughts, Cindy, we will miss your dad and laugh at the memory of his antics in our group
My heartfelt condolences to you and your family on the passing of your mom. My father was a great father, provider and friend to everyone he met. He would give anyone the shirt off his back. He loved his LOUD crowd group as well. Thank you for your kind words.
Sorry to see this about your mom. She was not only your mom, but she was your friend. I remember meeting her one time at your house. I thought you were a lot like her! I lost my dad in September, my best ever uncle a couple of weeks ago, and I am caring for my mom at her home after a fall and broken hip. She will be 90 in June. Some days it seems grief follows us….. but we continue to move forward and anticipate good days ahead. Keep your chin up Mary! Sure do miss you! We should chat soon… my new number is 703-851-3260.
Claire, thank you for your comment, and my heartfelt condolences to you as well. This post has resonated with alot of people, and no surprise, when in this fast paced world, we barely have time to process our thoughts and feelings. My house would also be empty if not for my toy poodle, lui, who follows me wherever I go, and provides comfort in his own way, as any animal lover knows.
Thank you, Sally for taking the time to comment
Rosemari, thank you for taking the time to share your own thoughts. There are some experiences we all share in life, and loss is one of them. How we make sense of it and keep our hearts open is the challenge.
I don’t normally respond to these, but having buried my own mother just a week and a half ago, unexpectedly, after she seemed to be improving from her chemo sessions and looking forward to my visit (She lived in Ohio, I live in
Wisconsin), I feel that same acute pain. Again. Yes, it comes in “spasms”…Mary, my heartfelt condolences to you, and to anyone else in a similar situation. Your suggestions are right on target. I’d like to add one more thing: don’t try to “bottle up” that grief. Allow yourself to express it, hopefully there are supportive friends, family, colleagues who will listen compassionately. but I’ve also cried out loud to an empty house. It somehow helps….
So sorry to hear of your loss. I thank you for your caring advice.
Mary, thank you so much for articulating this. My husband and I had this discussion last night. We termed it “reflective loss” – looking back and feeling and acknowledging the cumulative loss of the past year. How blessed we are to have people who understand and help us through these times. You, my friend and therapist, are one of those blessings. Give yourself the compassion and gentle care that you give to your clients.
yes, Lynn, I agree. I think of times a co-worker/friend has returned to work after losing a parent or spouse, and times goes on and we fail to remember to ask: “how are you doing?”
Mary, thanks so much for all you do! I, like you, have experienced losses and have experienced palliative and hospice care first hand with families, friends, and patients/families over the years. I am glad ethics and end of life care are gaining more attention! It is needed for all of us.
thank you, Candee
Excellent article Mary! So well articulated.
Jennifer, absolutely. I think we all underestimate the cumulative loss we feel of this second family we create
Thank you for this article Mary. The last year has proved very challenging for me and my colleagues at the PWR!Gym. There was an inordinate amount of loss experienced by all – both family and our clients. And your article really resonated with me. I hope I can share your thoughts with my colleagues and PD community. Thank you, Jennifer, PT