Excerpt from Lying Down in the Ever-Falling Snow: Canadian Health Professionals' Experience of Compassion Fatigue by Wendy Austin, E. Sharon Brintnell, Erika Goble, Leon Kagan, Linda Kreitzer, Denise J. Larsen, and Brendan Leier

The Icy Wall of Compassion Fatigue

Compassion fatigue deeply affects the relationship between the health professional and the patient. Rather than having a relational connection and attunement to the patient, the professional feels unable to reach out and connect with those in his or her care. Perceived failure in repeated efforts to make a difference in the suffering of others seems to create a form of indifference in the health professional. Veronica says compassion fatigue feels like indifference to her: It doesn't matter what is going on. It doesnrt affect you in any way, and it should. People's pain . .. misery . .. suffering should affect you. It's not normal that it doesn’t affect you. It’s not normal that you can see someone in severe agony and then go have your lunch as if nothing has happened. “Indifference” originates in the Latin word indifferentia, meaning “not differing, making no difference . .. of no consequence, not particular, careless. ”30 Bill, a psychologist, describes his experience of this: You have a hard time getting up in the morning; you really don't want to go to work. You might start showing up late for appointments; you don't prepare a lot for your appointments. You don't have a lot of hope; you wish sessions would go faster. When the patient before you is in dire straits, the compassion fatigue is particularly evident. Bill gives an example from his own experience: If you see someone who has killed their own child, the clock really stops. There is not much you can say to someone who has killed their own child. .. . What can one say or do? The horror of such a situation can entirely overwhelm the compassion- fatigued therapist.

Veronica believes she could definitely recognize compassion fatigue in a colleague. She thinks of someone with whom she works who to me is very pent up. She will curse, and she doesn't make chit-chat or small talk. She doesn't take interest in other things. She is always straight to work. She comes to work looking a bit disheveled or she looks tired sometimes. When I first met her, she was very warm and friendly, and now she is cold.

As we explored in this study what compassion fatigue is like, we examined images that seemed to capture it. Images—sculptures, photographs, paintings—of a person who is overcome, collapsed, and whose arms appear to have lost all strength seemed to catch the pervasiveness of the fatigue. 31 When the health professional can no longer reach out and enact a compassionate response toward his or her patients or clients, it is as if there is a coldness, an icy wall in the way. It is a progressively thickening wall that blocks one's presence to the other.

An icy barrier to family relationships can also form. For those who work in intense and demanding environments, it may often be difficult to leave work and relate to the less profound concerns of a family member. It can be difficult to act as if the choice of new wallpaper matters very much when one has just left a patient who has been told he cannot be cured. One health professional noted that she would try to listen to her husband's concerns about technical problems at work but that it took effort. Though she kept to herself thoughts of I'm thinking of someone who is dying of cancer, while your statistical analysis doesn't work out, such thoughts colour the empathy that otherwise would be there for him.

Justine, a social worker, was offered insight into the personal impact of compassion fatigue by her husband. He told her: Before [you had counselling for compassion fatigue] I would say something and you would just jump all over it or you wouldn't answer me or you'd be so preoccupied with something. You were so sad. And so, I just kind of stopped talking about anything that was important.

Lucille, an occupational therapist, says that compassion fatigue changed the way she interacted at home with her children. When it starts carrying over to your children who don’t know any better . .. I realized there was something going on. She knew she needed to be able to focus on their everyday concerns and to have patience helping them deal with them. Lucille eventually left her position.