Nutmeg, my forty pound hound dog, pounced into the air.
She landed in my lap before I had a chance to register the lightning. I heard thunder, and realized her fear was ignited by a sudden storm. Her body trembled. My chair rattled, not from the storm, but from her shaking. The corners of her mouth pulled back. She panted with increasing desperation, as if air would not pass.
Three years ago, I experienced my first panic attack. Suddenly, out of nowhere, sitting in a tiny hotel room near the beach, my heart raced. The walls closed in. For no apparent reason, I felt that if I didn’t escape the room, I might die.
For years I had heard people describe “panic attacks”. I imagined anxiety, fear. In this moment, though, anxiety didn’t begin to describe what I was feeling. I was a wild animal, caught in a trap, clawing and scratching, desperate to be free. There was no logic to this feeling. My room was calm, quiet, cool. I was with my husband and children, the people I love most in this world. And yet, my brain was convinced that my life was at risk.
Though I knew I was experiencing panic, no amount of deep breathing or kind self-talk could tame the terror. I left the hotel room, telling my kids and husband I was going to get some fresh air, hoping they wouldn’t notice the tension in my voice, my desperation to escape.
In the hotel lobby, the panic softened to a gentler anxiety, but I knew if I returned to the room, the panic would surely return in full force. I went outside. The warm summer air smelled like salt. I sat in my van, wondering if I should try to sleep there. Eventually, I headed back upstairs, and, in fact, the panic did return. This continued for sometime, until eventually I was able to calm into a steady, but tolerable state of anxiety. And then sleep. The next morning, I was fine.
Back to Nutmeg and her storm. With each flash of lightning, her body seized and shook. Panic, no other word for it. I tried to slow my breathing hoping she would sense my calm. I massaged her ears and neck, slowly and with deep pressure to help her notice her own body in the midst of her hijacked brain.
The storm lingered, and though the thunder wasn’t particularly loud, Nutmeg’s fear was unrelenting. Her panting grew more desperate. She opened the back of her throat, trying to get as much oxygen as possible. I could only imagine she felt something akin to my hotel-room, claustrophobic panic. My anxiety had been perpetuated by self-awareness, and snowballed into an inescapable physiological and psychological storm in my own brain. Could Nutmeg recognize her own panic? Could her fear of being afraid exacerbate her distress?
But this isn’t a story about panic. Nor anxiety. This is a story about compassion.
As Nutmeg sat, trembling in my lap, I didn’t feel empathy. I didn’t “try on” her panic, or attempt to share her emotions in my own body. While I remembered feeling panic in that hotel room, I didn’t relive that hijacked state of mind.
Instead, I felt deep sorrow, deep compassion. I allowed that compassion to guide my own physiology into a deeper, calmer, more purposeful state.
Rather than panicking with her, I settled my own breathing to hopefully help her calm. Instead of allowing my own throat to constrict, shortening my breath and raising the tone of my voice, I gently deepened my voice, speaking slowly and softly.
I also did something I often do with nervous patients. I spoke less. Clients, dog and cat owners, will often talk more - faster and in a higher pitched voice - when their pet is stressed. “It’s okay! Bailey! You’re okay! Good girl! Good girl! I promise it’s okay! Want a treat? It’ll be over soon!!” What does Bailey hear? The owner may as well say, “Yes, Bailey, you’re right to be terrified!”
Over years of practice, I’ve trained my brain to move into a calm space, even when I feel anything but calm. A patient arrives in respiratory distress. A client is screaming at the front office, furious over their bill. A team member comes into my office and shares a terrible personal crisis.
Whatever the situation, my voice reflexively goes softer and deeper. My pace of speech slows. A friend calls it my “doctor voice” and she says that, whenever I use it, she knows things just got serious.
When this voice emerges, I’m not taking on the negative, sad, or desperate feelings of those suffering near me. Not with my clients. Not with my patients. And certainly not with Nutmeg in her state of storm terror.
Instead, I move into compassion.
Sometimes intentionally, other times subconsciously, I assess how the canine, feline or other human in the room might feel. But I don’t linger there. Lingering there could be debilitating. Lingering there would be suffering with my patient.
Instead, my brain shifts into compassion. I am sad and sorry for them, but I am also present, willing to hold space, if needed. Willing to act, if appropriate.
For Nutmeg, I acted. Medications. Massage.
For a friend in crisis, I may simply listen. Being there.
For a devastated client, I may do both. Listening for a moment. Then moving into action. Should we treat? Should we end suffering?
Everywhere you turn, there is another article on compassion fatigue in veterinary medicine, another lecture, another webinar. We know veterinarians commit suicide at a rate significantly higher than the general population.1 The experts tell us “compassion fatigue” is part of the problem.
And yet, recently, I read that compassion, in fact, does not fatigue.
For years, maybe a decade, I saw the phrase “Compassion Fatigue” and my knee-jerk, gut reaction was to roll my eyes. Yeh. Not super compassionate, right? But really. I couldn’t stand the phrase. At the time, I could not pinpoint why.
Maybe, I felt offended? I had plenty of compassion for those who needed it.
Maybe I felt targeted. Did I really have to have compassion for every rude and demanding client? Was I expected to experience an entire smorgasbord of emotions every time a dying pet came in? Wasn’t it okay to acknowledge that death is a natural part of life? Wasn’t it okay to see euthanasia as a kind and sometimes beautiful option for a suffering patient?
Or, perhaps, I felt the “experts” simply weren’t getting it. My compassion wasn’t fatigued. I was tired from long days. I was anxious about being away from my young children. I was bitter because my daughter’s cancer diagnosis left me emotionally depleted, even as she celebrated year after year of remission. I was depressed because my son faced his own anxiety around school and separation. I was angry because I had six figures in student loan debt and, at the time, a five-figure income.
But, compassion? No. My compassion wasn’t fatigued at all. I was. And yet, in my exhaustion, I had exactly the right amount of compassion. No more. No less.
“Compassion,” writes Dr. Trisha Dowling, “Does Not Fatigue!”2
What?! What is this subversive information!
Instead, Dr. Dowling teaches us that the warmth and care experienced with compassion trigger positive cascades in the brain. Compassion, in fact, restores us.
Wow. Think about that for a moment. Sitting with Nutmeg, trembling in her fear, I am compassionate. And I am restored. Sitting with my client, as they sob, I feel sad for them - not pity and not my own sadness - simply, appropriately, compassionate. And I am restored.
Dr. Dowling explains that when we experience empathy, we may blur the lines between ourselves and others. We may “try on” or “take on” the emotions of the other. Empathy may be fatiguing. Compassion is not.
As I sat in my living room, listening to the downpour of rain, the occasional rumble of thunder, I simultaneously experienced compassion for Nutmeg and peace. That’s right. As she panicked in my lap, I was at peace. Not because I lack compassion. Not because I’m a sociopath. But because I enjoy storms. My emotional intelligence and healthy boundaries, cultivated over time, enable me to feel compassion for my pet and still enjoy a summer storm. The thunder, the rain, even the lightning, are all very soothing to me. While I felt sad for Nutmeg, I did not adopt her panic.
By staying calm and centered, I was there for her in the way that she needed me. My compassion never waivered. Never fatigued.
Compassion does not fatigue.
Those words give me a great deal of hope for my profession. I understand that there are many challenges facing veterinarians: emotional exhaustion, empathic distress, moral distress, financial pressures. And yes, veterinary suicide, a topic that is near and dear to my heart.
But hearing the phrase “Compassion does not fatigue” is very comforting to me.
You may be experiencing burn out. You may be exhausted. You may even be depressed. But somewhere, maybe deep inside, that compassion you knew as a young, pre-vet student, is still there. And in fact, you don’t need to fear it. You can’t give it away and deplete it. The more you tap into compassion, the more compassion you’ll find.
And, maybe, as you tap deeper into compassion, you may even find that elusive state of mind that all veterinarians could do with a little more of: self-compassion.
References and Resources 1. Dowling T. Compassion does not fatigue!. Can Vet J. 2018;59(7):749-750.
2. Tomasi SE, Fechter-Leggett ED, Edwards NT, Reddish AD, Crosby AE, Nett RJ. Suicide among veterinarians in the United States from 1979 through 2015. J Am Vet Med Assoc. 2019;254(1):104-112. doi:10.2460/javma.254.1.104
3. For more information on self-compassion, visit self-compassion.org