Is your heart too worn to care?

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I figured out the other day that I still care. I mean this facetiously, but it had been worrying me. Other veterinarians I talk to seem to be full of touching stories and emotional encounters with clients. I don't have a deep well of those even after 23 years in practice. One day in particular set this in stark relief for me.

Stop with the empathy and compassion all day, every day

I had just given an estimate for diagnostics to my technician to present to a client. I went back to my desk knowing that the client had no intention of proceeding further. My technician came back angry because, sure enough, they just wanted to treat symptomatically and "consider" diagnostics if no improvement was seen. As she vented, I looked at her and said, "Look at you! You still care! It's sweet."

My nonchalance at the situation made me wonder where my "caring" nerve had disappeared to. I'm sure I had it at one time, but I wasn't sure, even if I retraced my steps, that I could remember where I put it. "Certainly," I thought, "I care, right?" But not at the obvious same level that my technician just had.

Then I heard some parsing of language that made it more clear to me. Psychologists differentiate between sympathy, empathy and compassion. Sympathy is a feeling of care and concern for someone. Empathy is sharing in the emotions of someone else. Compassion is defined as suffering with someone else-a more engaged form of empathy-where we wish to alleviate the suffering of another.

"You can't care about the pet more than the pet owner. You will. But you can't. It's just not sustainable."

What my technician was expressing was compassion. Compassion is a good thing. It's what drives us into this profession and motivates us to excel. However, it can also be associated with guilt or frustration if our efforts to relieve suffering are thwarted. So many veterinarians end up with compassion fatigue because we approach every case, every day this way. I've often said that you can't care about the pet more than the pet owner. You will. But you can't. It's just not sustainable.

Compassion expends a lot of energy when we're arguing or trying to persuade owners to help us alleviate suffering in their pets. We blame ourselves, 100 percent, and act as if our lack of persistence is the only reason an owner (who's supposed to care the most about their pet) declines diagnostics or treatment. We tell ourselves we didn't do a good enough job. That isn't true, but it's how we're wired. Empathy, the down-gear of compassion, with either the owners or pets or both, can also be emotionally exhausting in a long-standing career.

I worry too-I just worry less

I recently had a difficult surgery and was especially worried because the owners weren't compliant with at-home instructions by even the most liberal of definitions. I lost sleep over this dog. I felt bad about the impact that a wider incision was going to have on the dog and the potential for bruising. I fretted over whether I sutured and ligated adequately. Even in trying to distance myself and intellectualize the surgery and after-care of what I can and can't control, my brain wanted to offer up all sorts of negative scenarios. In this profession our broad knowledge can sometimes be a detriment because we know exactly how badly things can go even when we've done everything right. Bottom line, the dog was fine. This situation reminded me how I used to fret at that same sleepless level over every surgery I did in my first five years out of school.

"You're not less of a person because you're dispassionate in the moment."

So, I think I still do care when a client declines to tend to their pet's needs. I care deeply. I just don't let it hurt me like it used to-like my technician still does. I think it's important to recognize that you're not less of a person, or less of a veterinarian, because you're dispassionate in the moment. In fact, this may be helpful in making rational and impartial decisions. We can still express sympathy toward a situation or plight without allowing it to scar our psyche.

If I could wish something for anyone entering this profession, it would be to have a shorter learning curve when it comes to mitigating these strong emotions. It's tough because that's how we've learned to engage in the world, and it's often how we are rewarded by others who see that compassion in us. I think it's like a relationship where you start off with this strong passion that flares like a newly lit match. Over time this flame becomes tempered and matures into a deeper, even more meaningful emotion. It becomes something that sustains us without burning us out.

A graduate of UC Davis School of Veterinary Medicine, Dr. Dean Scott has enjoyed 35 years in the veterinary profession, including five years with the U.S. Army Veterinary Corps. He now practices small animal medicine at Animal Clinic of Brandon in Brandon, Florida.