Cultivating Compassion While Battling Exhaustion

To the Editor: As a friendly Midwesterner, I find myself constantly giving people tours around the hospital and medical school buildings. Patients, applicants, colleagues, alumni, visitors—each demographic gets a different route; yet, few (if any) are shown the ever-growing list of “places I’ve cried.” As a fourth-year medical student with big feelings, I am well versed in the single-stall bathrooms, low-foot-traffic stairwells, and occasionally empty elevators of the medical campus. When reading the Invited Commentary “Compassion and Health Care: A Discussion With the Dalai Lama,”1 I immediately flashed to these liminal spaces. They allow a breath to appreciate the profound gift of being trusted with the most private, painful, joyous, terrifying, hopeful, devastating, and vulnerable moments of patients’ lives. They facilitate a moment to acclimate to the new weight that each story adds to our shoulders, before continuing about the rest of the day, which could be filled with another such connection, an unending list of frustrating care-coordination tasks, and note-writing, or, more likely, both. Medical trainees and practitioners do not lack the opportunity to practice compassion. Rather the opposite—the rinse and repeat of serving as caretaker and confidante for so many moments can induce a saturation effect, a compassion fatigue. How can we sustain this perpetual state of deep engagement, especially when providing care for those who hurl insults or remind us of the ghosts that haunt us? The authors assert compassion is inborn but sustaining it “requires mental discipline.”1 I have heard many students and residents express fear of losing much of the compassion that radiated (often clumsily) through our first patient interactions. Yet, as a medical trainee, I can attest firsthand that my colleagues exhibit unimaginable mental discipline getting through grueling call schedules, marathon surgeries, and thousands of flashcards. Attention alone is not enough in the quest to make compassion a way of life. Rather than additional competencies, we need the space to breathe and process the lives for which we are privileged to provide care and the weight that such responsibility carries. Rather than training, we need journals, poetry, art, and big feelings. Rather than a highlight reel of tour stops, we need to hear that it is okay to cry. Because once we do, we will be better prepared to bring our whole selves into the next patient’s room, with the capacity to deeply listen once again. Teddy G. Goetz, MSFourth-year medical student, College of Physicians and Surgeons, Columbia University, New York, New York; [email protected]; ORCID: https://orcid.org/0000-0002-1138-6602

Burnout · Compassion · Compassion fatigue · Feeling · Medical education · Political science · Shame · Clinical Psychology · Empathy and Medical Education · Healthcare professionals’ stress and burnout · Innovations in Medical Education · Law · Medicine · Nursing · Psychology · Social Psychology