Best Practices in Healthcare Management Begin With Self

Miki Goodwin, PhD, RN, PHN, NEA-BC; Kim Richards, RN, NC-BC


Nurs Econ. 2017;35(3):152-155. 

In This Article

Case Study 2: Compassion Fatigue

On May 5, 2014 at 10:04 a.m., my world profoundly changed. My extremely healthy, former Army Ranger and Gulf War 1 helicopter pilot, significant other (SO) was diagnosed with Stage 4 thymic carcinoma, a terminal and rare type of cancer. He experienced no signs or symptoms, yet the bottom of a routine neck X-ray done to track some stenosis probably caused from his marathon running days, showed a shadow in the top of his chest. "Probably nothing," said the thankfully aware radiologist. "Nothing" turned out to be a tumor the size of a grapefruit that wound itself around the great vessels, brachial nerve, and a portion of lung. One look at the film caused me to gasp in disbelief and become nauseated. I was positive they had mixed up the films with another patient. But no.

Ok, no worries, right? It's just a benign thymoma that can be excised by surgery. He was in perfect health and would be fine! We started looking at our calendars to schedule surgery at a convenient time for us, as if this tumor was simply an unwanted blip in the screen and we could, at our will, eliminate it from our lives and carry on our merry way. This would be like making a reservation for dinner, a seven-course dinner, but still, not a big deal.

I remember, like it was yesterday, sitting at my kitchen table waiting on an overdue phone call from my SO. He had texted me that the VA oncologist had asked him to stop by his office (odd, since the liver biopsy report was not due for another week). And I wasn't there. I was supposed to be there; I was a former critical care nurse and I felt guilty for missing a critical moment. Completely unaware of what was happening, I had begun the journey of all knowing, strong, and in control caregiver. In my mind, it was my role to handle all things medical.

I was still scared when my SO finally called me, his voice shaking in between tears. The news wasn't good. The liver biopsy had revealed a lesion, which put this "shadow" into an entirely different category. This shadow was death, 100% of the time, even with all the options available. "I'll be treated palliatively with chemo as an outpatient at the VA," he said, keenly aware of the ultimate outcome.

There were no words I could say other than, "I love you. They don't know you and they don't know us." I offered to come get him, yet he declined and somehow made it home. I immediately channeled my inner warrior nurse and "oh, hell no" attitude. I located the world-renowned expert in thymic carcinoma, and by the time my SO arrived home, I secured an appointment in 24 hours to "talk to a man about a cure." And that was that.

As I found out over the next couple of years of his treatment, and while I don't for a minute regret my support and devotion to my SO, the lessons I needed to learn about overgiving, compassion fatigue, and burnout were just beginning to rear their ugly heads. I was unaware that while my SO's disease management was mapped out perfectly, mine was not. I began sliding down the slippery slope of neglect and sacrifice of self. It was a journey I barely survived even though I have built a thriving business, published numerous articles, authored several books, and presented on self-care strategies to prevent burnout and compassion fatigue to hundreds. I learned it's easier said than done and I felt like a fraud.

In the distance, I had a feeling of becoming more detached from my life. I observed that even through all the busyness of battling cancer and seemingly positive progress, I became more and more lonely. I could not focus on my work, take on any more coaching clients, and the thought of writing an article or speaking on stage left me feeling overwhelmed and exhausted. Where I once leapt at opportunities, I became agoraphobic, apathetic yet easily startled. My adrenals were fried and I was numb.

I developed a checklist of sorts that allowed us something other than fear to focus on. Yet, it slowly became a one-way street with all energy flowing only from me to him. I eventually ran out of steam and selfishly felt this was becoming burdensome. At the same time, it perversely felt great to be somehow responsible for a positive outcome. I was a hero of sorts, managing all aspects of his care like an airport tower controller! But I realized I designed a toxic, unsustainable dynamic and I felt trapped.

I tried endlessly to get my SO to discuss his feelings. When I told him about my feeling of drifting apart and loneliness, he responded with indifference, which eventually became his way of being. After his treatments ended and he was (thankfully) in full remission, this indifference turned into seething anger, which was energetically palpable across a room. When gently confronted, he recoiled, so I pushed, and he withdrew. I pushed more, he clammed up, and I (sadly) quit trying. His mostly silent anger was all consuming. My house had become a hostile environment and now I was becoming ill.

We fought together, yet now we were clearly on opposite sides of a chasm as deep and wide as the Grand Canyon. I was no longer his partner, lover, nor best friend. Now I was the caregiver. My once highly resilient self had morphed into an anxious, depressed, unmotivated hot mess. My easy laughter and zest for life vanished – I was experiencing compassion fatigue.