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TITLE: Can I Lose My Compassion?
By Anne Warden

This is an article I wrote recently for nurses, but it can be appropriate for any of us.

The nursing journal, AMERICAN NURSE TODAY, has accepted it for an upcoming edition.
Have you ever found yourself in the middle of your day, working with your patients, when a regrettable flaw occurs in your caring and it causes you to wonder, “Am I losing my compassion?”

I have.

It’s a frightening thing to be wondering. Because what good are we as nurses without compassion?

Sympathy or compassion is sometimes difficult to retain. Physical exhaustion or administrative pressures can lead us to get so wrapped up in tasks we forget what’s truly important to our patients – or their hovering loved ones. But those stresses are not always what rob us of vital compassion. Sometimes it is our own attitudes.

Walk into a room where your middle-aged patient is requesting analgesics an hour after her radical mastectomy. The room is noisily packed with husband, adult children, grandkids, siblings and friends, so numerous they spill out into the hallway. They have come to wish your patient a speedy recovery. But look closely at their faces. In a few eyes you read fear and unasked questions. “Did the surgeons get it all?” “Will Mom survive this?” “What more must she go through before she’s herself again?”

You are able to feel compassion for every person there. And the way you handle their fragile fears and pain shows you care.

But go next door, where a disheveled, homeless man is lying. The entire room reeks of body odor and stale alcohol. He looks up as you walk in and curses – at you.

Now how easy is it to look beyond his outward appearance or his attitude? How easy is it to show this patient the same compassion you exercised with the previous one?

I heard a lecture by Fred Lee, the author of If Disney Ran Your Hospital: 9½ Things You Would Do Differently. He said, “The opposite of compassion isn’t apathy or indifference. ... It’s judgment.” When we let our judgments take the lead, we are in danger of losing compassion.

Most of us chose nursing as our profession in order to help people in some meaningful way. But when we thought the word ‘people’, just who were we picturing?

Did that original mental image include the dirty, down-and-out of society? Did it include chronic complainers - those we can’t seem to please, no matter what we do? What about people burdened with severe psychiatric illness? Or those our care system has labeled as drug seekers? What about those who appear to be racist toward us? Or registered sex offenders?

I was young, naive and prudish when I started nursing school. Like all of you, I’ve been assigned the care of many patients who eventually taught me to broaden my mental image of ‘the people I’m here to help’. And I’ve sometimes learned the hard way to replace judgment with true compassion. I’ve gone home regretting the way I treated someone.

There are some people who don’t want our ‘help’. Yet they do desire our compassion.

Long ago my husband and I built a house. The lead contractor (a man I’ll call Tony) worked with a hammer or nail gun in his hand, but he rested with an unfiltered cigarette in his mouth. Several years later that contractor was my patient, diagnosed with inoperable lung cancer. His oncologist told him the treatment would be ineffective if he didn’t stop smoking. When he wanted to go outside to have a cigarette, I repeated the warning to him.

What he said in reply was, “Why should I quit? I enjoy smoking. The treatment they’re talking about might cure the cancer but, if I have to give up my smokes, I really don’t want to live.”

If that had occurred early in my career, before I truly understood addictions, my reaction would have been different. The knowledge that tobacco use is the number one preventable cause of cancer would have made me frustrated with Tony’s unwillingness to give treatment a chance. Especially since I was already acquainted with him and liked him. That frustration would have colored my sympathy toward him in a negative way
and my care would have been less compassionate.

But fortunately, by then I’d learned it’s okay for the values of others to be different from my own. So instead of frustration, I felt sorrow – anticipatory grieving.

And the sorrow influenced my compassion in a positive manner.

After Tony died, my husband showed even more compassion when he said, “What a terrible price to pay for an addiction!”

Empathy is the Granddaddy of compassion. It is being able to identify first-hand with someone else’s suffering. Though it’s only presented to us when we experience our own distresses, it’s a gift to be highly treasured.

Many of us nurses have been around long enough to have had a ring-side seat at the brutal boxing match between Parent and Dementia. We’ve walked through the valley of the shadow of death with our own loved ones. We’ve spent our share of time sitting at bedsides, waiting for doctors to come discuss a diagnosis, a plan or a prognosis. These experiences cultivate empathy that leads us to become better nurses.

Some of us have been the patient. We’ve felt the helplessness and humiliation of just lying there exposed while someone else pokes and scopes and scans. We’ve trembled in fear (while trying to look nonchalant) as our gurneys were wheeled toward the operating room. We’ve come to know intimately how migraines or arthritis cripple. We’ve experienced the insidious erosion of our very psyches from chronic pain. From these experiences comes EMPATHY – in hearty doses.

For those of you who haven’t yet had the privilege of growing that kind of empathy, you can still retain your sympathy, your compassion. But it takes paying attention to your reactions. Admittedly it’s hard work to push a heavy judgment behind you. Retaining compassion takes the purposeful action of looking beyond your patient’s appearance, her history or his attitude. It takes focusing on what you read in the depths of your patient’s eyes.

Over the years, I’ve come to view the more ‘difficult’ patients as the same people I might be if I were in their shoes. How often have I looked past that difficulty into the eyes of an angry, distrustful or fearful person who just wants to be cared for with dignity and respect!

Do I still sometimes forget to force my attention beyond what is so easy to see – so front and center – and search for the deep well of my patient’s personhood? I’m sorry to say but, yes, occasionally I do. If I’m tired. Or stressed. Or tugged in several different directions (like a Gumby doll).

And I know I must pray often that I won’t allow an attitude of judgment to break in and rob me of that vital jewel of nursing – Compassion.

Copyright 2011. American Nurse Today. Reprinted with permission.
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