What Is Compassion Fatigue?

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Unprocessed vicarious trauma may lead to PTSD, yet managing it remains largely absent from medical training.

The compartmentalization skills that make physicians effective can become a liability when left unprocessed.

Small, intentional practices can protect physicians from the impact of accumulated vicarious trauma.

Note: Patient and family details have been modified to protect confidentiality.

When I walked into the room, she and her father were looking through old photos together. He was more present that day, despite the scabs and small areas of dried blood on his face, and the bruises still peeking out from beneath his hospital gown. She was doing her best to hold it together.

He had stage 4 cancer and had been on the verge of hospice when a traumatic fall brought him to us. He was stubborn, still fighting to hold onto his independence. It was the kind of stubbornness I recognized in my own father at an earlier time in our lives.

Now the conversation we’d been circling had to happen.

He was being transferred back to his in-network hospital, now more stable, with goals of care clearly defined: Hospice. She looked at me with tired eyes and asked me what I would do if it were my father.

She was reassured, and said, “I don’t know how you do it, doc.”

It was that kind of week.

In medicine, we sometimes joke about themed weeks. Some weeks we see multiple patients with heart attacks or strokes. This particular week had a theme none of us chose: hospice. Multiple patients transitioned to comfort care within a week. Multiple families navigating the hardest conversations of their lives. Multiple moments of sitting at the bedside, bearing witness to grief in real time.

For whatever reason, this patient stuck with me. Maybe it was the state he arrived in, or the loyalty he commanded of his friends........

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