The myth of compassion fatigue in veterinary medicine

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My friend and mentor Alice Villalobos, DVM, once asked me if I experienced compassion fatigue in my veterinary hospice work. “No,” I quickly responded. “I don't believe I'll ever run out of compassion.”

I went on to explain my thoughts on compassion fatigue and how I think it's an overused term in the veterinary industry. I told her that I felt more drained in emergency work than in hospice care, and that's when Dr. Villalobos said something that will stick with me forever: “I believe what we really struggle with in our profession is not so much compassion fatigue as ethical fatigue.”

Her assessment landed perfectly in my mind. In emergency medicine, I was rarely given full financial rein to do the very best for my patients. More often I was required to make decisions based on someone else's monetary budget, decisions that could arguably border on ethical dilemmas:

Do I run blood work or spend this money on immediate treatment?

Do I use minimal sedation to suture up a pet so I have funds left over for pain medication and antibiotics?

Do I tell this family their pet has a 5 percent chance of living a few more months, knowing they will drain their savings account or go into debt just to get a little more time?

Do I euthanize this sick kitten that was just dropped off because we don't have any foster homes?

These are ethically based decisions, not compassion-based. We all know that if we do not choose to negotiate this path with some clients, they will make a drastic decision (like euthanasia elsewhere or perhaps an unfair negative online review), which may lead to the pet not being helped at all. And to me, that is the ultimate failure.

In contrast, according to the Oxford English Dictionary, compassion fatigue is an “indifference to charitable appeals on behalf of those who are suffering, experienced as a result of the frequency or number of those appeals.” Basically, it means you stop caring because you're required to care so often. Anyone in any kind of long-term caregiving capacity should be able to understand compassion fatigue, including parents.

“I believe we are more fatigued by the ethical decisions we have to make for a pet based on a client's poor choices than we are by the perceived finite amount of compassion we believe exists within ourselves.”

While I understand compassion fatigue, I just don't relate to it. I've cared for my infant child who didn't sleep through the night for 11 months straight. I've attended to nine in-home euthanasias in one day. I've dealt with case after case in the ER, day after day. We all know the feeling of peeling off our socks and lying down in bed after more than 24 hours on the job, only to be awakened by a text or phone call from the clinic (or even a friend) with a question about another pet.

To me, this isn't compassion fatigue. This is being overworked, underslept, burned out or simply really, really exhausted. In such moments, I'm not lacking compassion. I'm lacking rest (or a Snickers bar!).

The overuse of the term “compassion fatigue” can be a dangerous path for our profession, which is why the distinction between it and “ethical fatigue” has been so inspiring to me. Instead of using compassion fatigue to describe any negative emotion we experience on the job, diving deep and understanding our unique stressors offers a much more holistic approach to a healthy working environment. This was an important journey for me early on in my career and has made a huge difference in my emotional health.

Years ago, when a pet owner presented me with my fourth parvo puppy of the night and then proceeded to become angry because she believed I was “just in it for the money” and that I “must not care about animals,” I did feel like my compassion had been completely drained. I thought, “How can I possibly care when this person doesn't realize the dedication and drive it takes to deal with people like her-especially when parvo is completely preventable with a $15 vaccine?”

Interactions like these used to drain me. But as I watched this woman get angry with me, her 8-year-old daughter sitting in the exam room wearing clothes that clearly hadn't been clean in some time, telling me she would beg on the side of the road to pay for her puppy's treatment and that I was a terrible person for making her do that, I realized her anger had nothing to do with me. With all the struggles she must have had in her life, it took bravery to bring her pet into a clinic where she surely knew she couldn't afford treatment.

I looked at her and said, “I want to thank you for bringing Piper here, and I'm so sorry if you feel judged by me or my team. Let's figure something out together.”

Her anger subsided and she calmed down. I realized there was something worse in this world than being berated by a client's misdirected anger. It was that puppy dumped and left to die on the side of the road with no person. It was letting that little girl feel that a veterinarian didn't want to help. Seeing this woman as a human being instead of someone who was “out to get me” changed my perception and changed what was possible.

“I am the source of my own compassion. Therefore, it will never run out.”

Immediately, the compassion I had for the puppy drove my decisions because my self-defensive guard was down. Instead of being overwhelmed by a lack of desire to help the woman, I was able to concentrate on the need to help the patient. And most importantly, I began to realize something about myself-you can't give what you don't have, and as long as I was my own source of compassion, I would never run out.  

I realize this may not apply to everyone, but as a woman and a mother, I believe I have an endless supply of compassion. In hospice practice I work with people every day who need empathy and support, and I never feel drained by them. Do I feel tired, stressed, overworked, underslept and perhaps a little burned out at times? Of course, but that's not compassion fatigue. It's having an empty tank, and it can be refilled by engaging in things that bring us joy.

Simply put, it was not an overdraft on my compassion supply that led me to feel fatigued. It was the immense responsibility to make the right decision within the boundaries of someone else's (often) illogical values or unreasonable budget. That is not compassion fatigue; it's ethical fatigue.

Dr. Dani McVety is owner of Lap of Love Veterinary Hospice and In-Home Euthanasia in Lutz, Florida.