Feeling the burn

It is a cool, midsummer’s night, and a middle-aged woman sits at a DATA bus stop clutching an empty pill bottle. She surreptitiously pockets it as the ambulance turns the corner, and begins to clutch at her chest with the fake pain of the prescription drug addict seeking her next hit.

Cut now to the parking lot of Durham Police headquarters: Paramedics approach the back door of a squad car, whose sole inhabitant is feigning unconsciousness, ignominiously sprawled across the back seat. Metal cuffs bind the hands that, just hours earlier, took the lives of a young couple in a brutal home invasion.

One last cut, this time to the triage desk at UNC’s emergency room: The triage nurse, not looking up from the computer, asks the paramedic, “What’cha got?” The medic, betraying his bored impatience, says, “Fuzzy Wuzzy.” The nurse looks up at the mention of the alias, his eyes coming to rest on a portly, bearded alcoholic, one of the hospital’s well-known “frequent fliers.” With sarcastic pleasantry, he exclaims, “Fuzzy Wuzzy! I haven’t seen you since … [hurried keystrokes] … this morning. Room seven.”

Let’s talk about compassion, a word that gets thrown around a lot on personal essays and med school applications. I didn’t feel a single modicum of it for any of the patients in the above stories. Don’t get me wrong—I’m not going to spend the rest of this column arguing that compassion is overrated, or that it does not occupy an important place in the practice of modern medicine. My problem is that people are wont to blindly extol the supposed wonders of compassion, as if you can draw up and administer 30 mg of it as an instant cure for what ails ye. With the widely-held view that compassion should be a given in medicine, the public is quick to lash out at providers who are perceived as being less empathetic in their interactions, regardless of the provider’s overall competence or professionalism. The phenomenon underlying this deficit of empathy is called “compassion fatigue”—many are more familiar, however, with the near-synonym “burnout.”

They told us in EMT class that burnout is not so much a possibility as an eventuality: All providers will ultimately be rendered emotionally numb by the constant, unyielding stresses of the job. The warnings completely failed to resonate with me. I couldn’t help but dismiss the notion that my patients would wear me down—after all, I had considered my patients to be my primary motivation as a medical provider. As such, my thought process went, I had an obligation to be compassionate, and if I were to become unable to deliver on that obligation, well, that would be the day I quit.

But despite the various indignant protestations to the contrary, you can’t always consciously control your empathy. It’s hard to feel compassion for the drug seeker or the frequent flier. It’s even harder to feel compassion for the drug-seeker or the frequent flier when you see them a mere hour after watching a 19-year-old die in front of you after being pulled out of a house fire. It’s harder still to muster any shred of compassion when the man before you just painted a kitchen wall with his sister-in-law’s brains. The constant juxtaposition of the odious with the mundane, the affable with the abrasive, begins to take its toll; how can you pronounce the time of death for a 13-year-old girl shot dead in a drive-by, and then respond to a 911 call for a toe infection while maintaining the same empathetic emotional state? I’ve witnessed all the frightening signs of burnout in partners: diminished interest, lack of compassion, fragmenting personal lives. What’s scarier is when you look in the mirror and start to see that small seeds of compassion fatigue have been sown and are growing insidiously within you.

With that said, I certainly don’t believe I’ve burnt out, though I have come to some sobering realizations about the practice of medicine. Medicine is not a shiny, happy field. You will not leave work every day feeling as if you have made a difference. Most of the time, you won’t really be feeling anything but drained. Your obligations to your patients are competence and professionalism—this despite the fact that you will routinely have patients who frustrate you, curse at you or even try to attack you. Much of the time, you won’t even be thanked. You’ll deal with stressful circumstances and be expected to sequester that baggage from your personal life. And yet, I know now more than ever that medicine is what I want to do with the rest of my life. I’ve come to terms with the fact that the medical profession is a job that, every once in a while, is worth it. It’s that one infrequent time when everything goes right. Or that one rare instance where you do make a difference. Or even that one uncommon display of sincere gratitude from a patient. Somehow, those moments are enough to make it all worthwhile.

Jay Srinivasan, Trinity ’14, is a Duke pre-med. This column is the 10th installment in a semester-long series of weekly columns written on the pre-med experience at Duke, as well as the diverse ways students can pursue and engage with the field of medicine.