Weeks 4/5: Compassion fatigue and brain fatigue

Sorry I didn't post last week.  The past two weeks have been more difficult than the previous three.  I've been having some strange thoughts recently about vet school and I wanted to get them out.  This is not my typical, "here's what we did this week" type of post.  Rather, it's more of a self-serving exercise to try to help myself understand what I am feeling.

After four weeks here, I'm starting to get a feel for what the next four years are going to be like.  In only four weeks, I notice subtle changes in myself and how I view animals and medicine.  I remember quite distinctly the queasy feeling in anatomy the first week when we opened up our cadavers for the first time and the hesitant and careful way we cut through the skin.  One of our classmates fainted and my table mate commented to me that it had restored her faith in our humanity.  After all, if 100 of us were cutting into these donated pets, shouldn't at least one of us have a problem with it?  I know that's an oversimplification and that fainting is not the only way to experience hesitation, doubt, and discomfort, but nonetheless it got me thinking about the kind of people that the medical profession selects.

I remember being both amazed and intimidated by the precise and confident way the professors sliced through tissue in my first anatomy lab session.  Four weeks later, I find myself cutting quickly though skin, tearing facia with my hands, and only because I can see it differently.  I can now see it as an obstacle, something in the way of my visualizing the muscles and learning the material for the day.  I even felt a tiny tinge of resentment today dissecting the distal pelvic limb at the excess of facia that needed to be cleaned away.  When we finally exposed the stifle (knee), the dog had some of the worse osteoarthritis I'd ever seen, which granted, I've not seen much, but even the professors commented on its severity.  My first thought was, "cool, I've never seen anything like that before." My second thought was, "That was wrong.  This poor dog was probably in a lot of pain before he died and you just told yourself it was cool."  In the beginning, I remember seeing all of the tissue as being part of the animal whose body had been donated for my learning.  I felt both shy about "damaging" the body and nervous that I would do it wrong.  I can still see the animal as a whole and feel the need to respect it, but I feel a certain amount of distance from it and this is what scares me.

On an intellectual level, I understand the need for distance in the medical professions.  Not only do veterinarians need to maintain distance to protect themselves from the constant emotional barrage of dealing with sick patients, worried owners, euthanasia, and all of the other difficulties of the profession, we also need distance to protect the patients from the effects of our emotions on our decision making.  In the early nineteenth century, doctors and veterinarians in training would learn about anatomy through vivisection of live, and often unanesthetized, dogs, cats, and other unwanted animals.  It was thought that  constant exposure to the cries of these animals would harden the future surgeon and prevent him from forming emotional attachments.  I'm certainly glad to not be studying medicine back then and we have come a long way in terms of animal welfare.  Now we value the human animal bond, we offer as much compassion as we can manage to our patients and their owners and I have to admit, I'm scared.  I'm scared that my heart isn't big enough for all of the patients I will have or strong enough for both compassion and objectivity.

We learned this week about something called "compassion fatigue," which results from the chronic stress of dealing with the suffering of others.  We had an entire class devoted to recognizing the signs and combating the symptoms.  I can say this class is not a moment too soon and I am so glad that they included it in the first year curriculum because hopefully now I'll be more sensitive to my own emotional state as I progress though my training.

In other class news, I had my second exam this last week, this one for developmental anatomy.  I felt reasonably good about it, but every exam I have wiped me out and this time I only has a three day break before my next exam (physiological chemistry) on Tuesday and I struggled to snap back fast enough to study effectively.  I understand that this is what the next four years are going to be like, one exam after another and I am so thankful for my study group to keep me sane and at least moderately focused.  I feel that I'm going into my Tuesday exam less prepared than I have been for my previous exams, but I have to be okay with doing my best and letting whatever happens happen.