Friday, September 22, 2006

Compassion Fatigue

I think a good writer is partially defined by their ability to shape a thought; to cut out extras; to craft a piece of work where at first seemingly unrelated paragraphs are later revealed to be integral and precisely inserted. I don't feel much like a good writer tonight. I start my first overnight shift tomorrow night and so I'm up tonight, trying to push the sleep away so that I'm not undead in the wee hours of the morning tomorrow. And my thoughts are swirling and buzzing and glancing on each memory, trying to impart meaning, to make an image into a symbol of my mood, or an explanation for my emotional busyness. It feels like a vigil of sorts, only most vigils I can think of aren't conducted with a can full of soda and a laptop computer. And the word vigil seems to make it heavier than I want. Perhaps it's just this up late at night when the world is asleep vibe. Emotional busyness seems more apt than turmoil or confusion. It wasn't a bad day, or even a bad week. Here's why I write: not to be a good writer (although I figure I can at least spell, string a sentence together and maybe know how to use a semicolon properly), but to hone myself; to figure out what is extra; to make connections.

I want to whine about evening news programs, which I have to admit I watch rarely (and by that I mean maybe once every six months? Every eight?), but tonight I was trying the bad TV method to start off the hopeful insomnia fest. And hey, if you don't watch I guess you can't complain, so now I can just go right ahead. I mean, what is the deal with some couple's private infertility troubles headlining the news? Now I'm usually the first to complain about all the depressing murder/gunshot/car crash/reads like a combination of an episode of "COPS" and some made for TV detective movie crap they like to show (nowhere is life so depressing as when one considers the possible truth in demographics revealed by ratings), but I'm sorry, I really don't want to know about some poor couple's fertility issues, no matter whether there's a putative legal issue that somehow catapults this into the "public" forum. Aren't you folks suspicious when the first story is just interviews between the TV news people and the newspaper journalists who are also making this the headline news of tomorrow's local newspaper? Oh, and THEN on to the body parts and mayhem. And the only news of Iraq is another local man killed, and some local peace protesters arrested, without any true commentary. Needless to say, I turned off the TV before I became some cynical private version of MST3K in my one living room. (Newscaster: "Tell us, oh expert psychology witness, what could it mean that the victim was chopped into pieces before he was thrown into the river?" Expert: "Well, it could be that it was a professional job--purely business--or perhaps the victim and the killer had some kind of relationship [my emphasis]." Me: "Of course there was some kind of relationship, you idiot! It's awfully difficult to chop your own self up and throw yourself in the river!")

And then I look over on the couch where Foo Foo is sleeping the contented sleep of the well-fed dog allowed on the furniture, head on a pillow and one foot dangling off the sofa, and I think, a little guiltily, about my ranting post of a few weeks ago. And while the rant is still very true in some sense, it, of course, is a rant. Something to blow off frustration, and to hide the other parts of self-doubt and exhaustion, and something that is only one sliver of a complicated whole. I don't want to be sorry, because I'm sorry too often anyway, and I feel the need to claim my own anger and frustrations that come with dealing with stressed (or drunk, or angry, or manipulative) people in any people service job. (Talk to your friends who wait tables, if you have them--they'll tell you.) And while it's medicine, people, it is ALSO a service job.

But tonight I'm thinking about other aspects of what I do. And I'm thinking about my own dogs, who have to put up with things normal dogs don't (I guess sort of a twisted kind of analogy to kids whose parents make them endure profession related embarrassment, like coming to their school to teach sex ed, or something--sorry, it's late, my analogies are growing weak). My dogs have a mother who palpates their abdomens for practice, or lends them to the cardiology department to try out their new ultrasound machine, or gives them a wacky hair cut so that she can try out her ultrasound skills. And I look at my dogs and tell them fiercely that they are NOT allowed to get old, they are NOT allowed to get sick and die. The thought just wrecks me.

This is the crux of tonight: this post is for the ones I couldn't save. You know, I don't have any time to stop and absorb things during a shift, especially when receiving emergencies. So I often feel like I'm handling things fine. But truly, these days catch up with you when you are sitting up, trying to stay awake, watching trashy TV. And you find yourself weeping over the overplayed drama because you need to, you need to cry about something, evening if it's something else. Now I realize that this is what they're talking about when they bring up the danger of "compassion fatigue" in the medical profession. It's only three months in, people, and I have seen so much death. I'm not talking about any deep ethical debate on euthanasia in this moment. I'm just simply thinking of the ones that were broken, that were not saved, for whatever reason. This is not about judgement.

This is about the terrible balance between a heart that has trouble pumping and a potentially lethal threat to the kidneys. This is for the 13 years you spent with him, and the car that ended it. This is for all you foolish ones who ate what you weren't supposed to, who got old, who never had a chance, who were loved, who were never loved.

I'm sorry. I'm so sorry I could not save you, that I could not fix everything, that I never had a chance to even start. I never walked into this expecting to be able to heal everyone; I expected death as an inevitable companion. And yet, I am still sorry.

This poem has always been an amulet, an instruction manual; a way to encompass grief.

In Blackwater Woods

Look, the trees
are turning
their own bodies
into pillars

of light,
are giving off the rich
fragrance of cinnamon
and fulfillment,

the long tapers
of cattails
are bursting and floating away over
the blue shoulders

of the ponds,
and every pond,
no matter what its
name is, is

nameless now.
Every year
I have ever learned

in my lifetime
leads back to this: the fires
and the black river of loss
whose other side

is salvation,
whose meaning
none of us will ever know.
To live in this world

you must be able
to do three things:
to love what is mortal;
to hold it

against your bones knowing
your own life depends on it;
and, when the time comes to let it go,
to let it go.

Mary Oliver