Trembling of the Heart
Updated: Jan 24, 2019
Veterinarians are trained to be healers, professionals who understand all the ways the body can fail and all the ways it can hurt, and how to coax it back towards health, or at least treat the symptoms. We are expert creative problem solvers, and when it comes to end of life care, we are very good at using these skills to relieve pain, nausea, and other symptoms of terminal and chronic illnesses.
Our objective, most of the time, is to prolong life. Until it's not. In our culture, it is easy to forget that death and dying are not always diseases we must manage and cure. Like birth, death is a natural part of life, and sometimes we have to resist the clinical urge to intervene and "treat" and instead, to humbly sit in the darkness with our patients and their families. The dying and the bereft need our compassion to give them strength, as much or more than our expertise.
Death, like birth, is a life event when we as healers move from a place of treating or curing to a place of caring and compassion. Instead of leading the way, we must step aside and hold space for the patient and family to create the kind of journey they need and want. It can be painful to watch the pain and struggle of another, and not be able to take it way, especially as healers.
Brene Brown made a wonderfully illustrative YouTube video on empathy, and its qualities: perspective taking, staying out of judgment, recognizing emotion in the other, and communicating that.
But I am also not sure I totally agree with Brene Brown on this, either. I think we do not have to always get in the hole with the suffering person to understand how they feel, and to want to help them out of the hole. In fact, I'd argue you are often better suited to help them, or to help them bear their pain, if you aren't in the hole with them. This is where compassion comes in.
Compassion starts with empathy--we see the pain and understand the pain of another--but takes it one step further with a desire to help them AND a readiness to do what is necessary to help them. Sometimes that means getting in the hole and holding their hand, and telling them not to be afraid of the dark because you are there. And sometimes it means throwing them a rope and telling them to grab 'hold, you will pull them out. And sometimes it means lighting a candle and holding space.
As veterinarians, we struggle with "compassion fatigue". I think this term is often overused/misused often, and what we really suffer from is ethical fatigue, empathic fatigue, decision fatigue, physical fatigue, work/life imbalance, and not setting boundaries. Feldman and Kuyken define compassion as "a response to suffering, the inevitable adversity all human beings will meet in their lives, whether it is the pain embedded in the fabric of ageing, sickness and death or the psychological and emotional afflictions that debilitate the mind. Compassion is the acknowledgment that not all pain can be ‘fixed’ or ‘solved’ but all suffering is made more approachable in a landscape of compassion." We would do well to remember this last part (not all pain can be fixed) and to make peace with "the inevitable adversity all humans will meet" if we wish to practice true compassion.
Veterinarians are, in general, empathic, sensitive people who can understand the pain and suffering of an individual from another species just by watching them and reading their body language, often better than the individual's familiy. We must face pain and suffering, lean into it even, but learn how not get so sucked in so that we can't see the way out. The more we can lean into pain, and accept the pain we can not treat or cure (the pain the patient has already experienced for months, the pain of loss and dying), the better we will be able to treat the pain of the here and now, to hold space for the dying and bereft, and to face the pain of tomorrow, in our next patient.