The Death of Compassion

In August 2006, a baby girl was born. I became intimately involved in her life in a way that would forever change me and my view of the world.

As a busy Obstetrician/Gynecologist, I arrived early at work that day. With some 15 patients to see before I was to do a scheduled Cesarean section at 7:00 AM I wanted to make sure everyone got plenty of attention before I was to be unavailable in surgery. One of those patients, Mrs. H, had delivered her baby girl by emergency C-section during the night and was recovering from her surgery. Most surgical deliveries and recoveries go smoothly, but Mrs. H was coming around more slowly than usual. I had a discussion with her, her husband and her nurse about her situation and how I planned to monitor her closely throughout the day before I went to perform the 7 A.M. Cesarean.

Despite my best intentions, there was a perfect storm brewing. Being the end of summer, all of the doctors in our large women’s clinic were either out on vacation or off that day save for one who was seeing patients in the office. I was on call for the group which meant that I was responsible for any of the patients in our busy clinic who’d happen to go into labor that day or have another issue that needed to be dealt with emergently.

Being a for-profit industry, it was (and still is) the culture in that hospital and clinic to attend to as many patients as possible, seemingly despite the consequences to the health of patients or providers. I had willingly adhered to this cultural standard during my training when I routinely spent 80–100 hours per week at the hospital despite having a new baby at home, two other children and a husband to care for. It didn’t seem to make any difference that the cultural standard was set by men who don’t have the same need to juggle career and family life in the way that women do. I actually embraced this challenge for many years and was considered an empathetic, compassionate and skillful physician and surgeon.

However, on this day the challenge was to become a struggle, and ultimately a war, as I was notified during the surgery that my patient, Mrs. H, seemed to be taking a turn for the worse. Unfortunately her symptoms were vague and confusing, and didn’t fit any particular diagnosis or recommended mode of action. As I spent a couple minutes pondering her case, I was called to attend to several other patients who also needed my attention.

At that moment, standing outside the door gazing at her chart, I was struck by an overwhelming sense of impending doom, along with the realization that I had made the wrong choice in becoming a physician. You see, I knew then that Mrs. H would probably die from whatever this condition was and that I would be blamed for her death, even if it turned out to be from natural causes. I had seen it happen to other colleagues, who had been accused of “malpractice” in the courts, when they had been compassionate doctors just doing their job to the best of their ability.

On this day, had I been brave enough to speak vehemently on behalf of this patient (and myself) about my need to spend some time taking care of just her, the pain and suffering that ensued upon her death (later indeed proven to be due to natural causes) might have been lessened.

It is a fact of life that mothers die, sometimes in childbirth. Fathers die, babies die, doctors die. Only the heavens know when that day will come for each of us. Physicians need to be able to accept this one fact of ”life” if they are to survive their careers. Having personally suffered miscarriages and infertility, I was well acquainted with death and loss, and went into medicine specifically to help women facing similar challenging experiences. My patients often told me that I helped them in ways that were beyond what the average doctor was able to, and I treasured this aspect of my career. My ability to assist people as they are going through the great transition of becoming a mother is one of the things that drew me to OB/Gyn.

My sense of impending doom that day had everything to do with the cultural standard that required me and other doctors to spend as little time with patients as possible so that I could take care of as many people as time would allow, thereby satisfying the projected quarterly income requirements for the institutions where I practiced. I realized I was working for the institution and not for the patient, and despite whatever the patient had to say about me or my care, it was the institution that had control over my ability to spend as much time with patients as they required. It was “All About the Money”, and this patient and her family were the red flag that finally convinced me of that fact.

This went against my basic philosophy of “First Do No Harm”, adopted the day I received my Medical degree and recited the Hippocratic Oath. Being restricted from spending time with patients is harmful to both patient and doctor. It resulted ultimately in a great loss for me, the loss of my sense of Compassion. For compassion can indeed be looked upon as another sense, just like our sense of hearing or vision. We need it to survive; compassion first for ourselves, and then for those outside of us. When we’ve lost our sense of compassion, we literally become a danger to ourselves and others. We lose our ability to be empathetic, discerning, and merciful, qualities that keep more negative emotions in check. The good, kind, loving aspects of our character give way to scheming, manipulation and control, and we are more likely to cause harm, whether we intend to or not. Even the hardiest of souls, those you would never expect, can succumb. In my case, losing compassion for the system and those who championed it that would “throw me under the bus” in an effort to dodge blame for this woman’s death had far-reaching effects. I lost compassion for myself as I tried in vain to figure out what I had done wrong.

In 2013 I became aware that I was suffering from a particularly debilitating case of Compassion Fatigue, a condition caused by combining Burnout with Traumatic Stress. Burnout is caused by living or working in a toxic environment, while traumatic stress is caused by being exposed to traumatic events in one’s own or another’s life. The practice of western medicine (for profit) is very toxic, as providers are discouraged and even legally sanctioned against taking care of themselves. For example, it is difficult to obtain or keep a medical license if one is afflicted with a “mental illness” such as depression or anxiety. When a doctor is sued (and almost all suits are assumed to be due to “malpractice”), it is natural for him or her to become somewhat anxious or depressed about the possible outcome of the suit and question his or her own competence. Furthermore, he or she is prohibited from discussing the situation with anyone, thereby creating isolation when one needs support the most.

The events of 2020 and 2021 have been “Compassion Fatigue inducing” for almost everyone. We are burned out from trying to rationally deal with extreme toxicity in the institutions that govern us as well as in the societal structures of which we are a part. We are continually being bombarded with news of traumatic events in other’s lives. We are isolating ourselves, either voluntarily or to comply with mandates, which is weakening the natural connections we have with each other. These are connections that can help strengthen our more positive qualities and are a natural deterrent to the negative behaviors noted above. Once they are weakened or destroyed, we can see even close family members turn on each other. Then we are really lost.

Since being diagnosed with Compassion Fatigue, my whole focus has changed. I’ve gone from being a chronic people-pleasing caregiver to someone who’s learned that without vigilant attention to my own spiritual, mental, emotional and physical health, I am just as prone to the manipulative, controlling and self-serving attitudes and behaviors as those who have caused me harm. This knowledge alone does much to keep me focused on doing those things that enhance my well-being, for in my heart I know that I am not a person who endorses or perpetuates harmful actions and behavior. It is my responsibility to stay true to who I am and to do whatever I can to prevent myself from becoming involved in situations where I might intentionally or unintentionally lose my balance, no matter what others might choose.

What to do?

Some suggestions:

• Spend time in nature and/or with animals
• Practice gratitude
• Have a regular spiritual practice such as meditation, prayer, yoga, or something else that resonates with you
• Limit exposure to toxic people and situations
• Prioritize your well-being
• Set aside time to do those activities that you love
• Surround yourself with things that bring you joy
• Practice kindness
• Focus on what’s important

With some effort, I know we can bring compassion back to life. We will certainly need it to tackle the challenges that face us.