You’ve heard of “burnout,” right? Your work environment is making you miserable, so miserable that you feel unfulfilled, depleted of energy, stripped of all motivation to effect change in the workplace. If you’re a healthcare professional, undoubtedly, you know all too well about burnout. But then there’s “compassion fatigue.” While individuals working in any kind of job setting can experience burnout, compassion fatigue is unique to those exposed to trauma while working in a helping profession: nurses, firefighters, police. Because you’re in the helping profession, you feel the onus is on you to save peoples’ lives, to make them better, to alleviate their pain, so you sign up for extra shifts, and, if you’re a nurse, offer to take care of the sickest patients. But what happens when your patients have little, or no family support, or are constantly ringing the call bell, making demands (get me water, I need more pain meds, I need something to help me sleep)? You feel like Sisyphus – no matter how many times you push the boulder up the hill, it keeps rolling back down into your weakened arms. You’re worn down, irritable, angry. That’s compassion fatigue, when you can no longer muster the sympathy to care for your patients because you’ve been exposed to the same kinds of patients again and again, and have answered an uncountable number of call-bell dings, but the bells keep dinging, and you want to keep helping, but, at the same time, you want to run.

It’s worth noting, however, that compassion fatigue doesn’t necessarily mean individuals experiencing it lack compassion, not at all. They still care about their patients. Instead, as a nursing professor at the College of Nursing at University of Arizona says, compassion fatigue is more like feeling too “full,” and even suggests a different name for it: “emotional saturation.”

Not only are healthcare professionals at risk for compassion fatigue, though, family members caring for loved ones with, say, a traumatic brain injury or dementia, are at risk too. Even those who hear about another’s traumatic experience over and over again are affected. I bring these scenarios into the mix because, sadly enough, I suffered from compassion fatigue when I worked tirelessly to navigate my father’s emotional swings, and, as he slipped into Alzheimer’s, made sure he was safe at home because he had insisted he never be put in a nursing home. And I’m witnessing compassion fatigue again, as my husband and his siblings stumble then pick themselves each day, determined to keep their aging mother safe from the ravages of dementia.

But it is possible to care too much, so much that it hurts. When I say hurt, I mean really hurt, as in traumatized hurt. Being pre-occupied with others’ suffering can cause “secondary traumatic stress” for the helping individual. It’s not unusual to experiences symptoms of post-traumatic stress disorder: anxiety, hyper-vigilance, irritability, impatience, withdrawal, poor concentration, sleep disturbance, nightmares, the list goes on.

What’s the cure for compassion fatigue? Boundaries and self-care. In other words, set limits, say no even when you want to say yes, remind yourself to take time out, meditate, go for a walk, keep a journal, draw, listen to your favorite music, dance, do yoga, take a bath, read a novel, watch a funny movie. Watch the sun set. Watch the sun rise.

For more resources on how to evaluate whether or not you have compassion fatigue and how to prevent/treat it, go to compassion fatigue and healthy caregiving.

Are you a neonatal intensive care nurse? Do you believe we should save premature babies born at twenty-two weeks? What kinds of treatments does it take to save a fetus whose viability is uncertain?

The New England Journal of Medicine recently published the results of a study showing the outcomes for five-thousand babies, born between twenty-two and twenty-seven weeks, at twenty-four different hospitals. The purpose of the study was to see if differences in hospital practices regarding initiation of treatment for these babies could explain the variation in survival with and without impairment. No babies born between twenty-two and twenty-three weeks survived without treatment. A small number received aggressive treatment, and a fraction survived, some with significant complications.

Researchers hope the study will offer physicians solid data to help them council parents. Undoubtedly, it will fire-up the debate concerning the age of viability. In a summary of a 2014 workshop, the American College of Obstetricians and Gynecologists and the Academy of Pediatrics noted that babies born at twenty-three weeks should be considered viable, as more than a quarter of them survive with intensive treatment. In the summary, it also states that no treatment is helpful for babies born at twenty-two weeks. The gray zone occurs between twenty-two and twenty-three weeks. Survival depends on factors such as birth weight and whether or not the mother received steroids prior to delivery to help the baby’s lungs and brain.

That is a narrow window. If a mother is ready to deliver at twenty-two weeks and six days, do we say, “sorry, there’s nothing we can do?” Add to that gray zone the reality that due dates are an estimation. What if that same mother was really twenty-three weeks pregnant?

In 2001, as a NICU nurse at a large teaching hospital, I cared for a baby born at twenty-three weeks. Her eyes were still fused shut and her skin was so thin the nurses only changed her diaper when absolutely necessary to avoid any injury. We kept her on a ventilator for twenty-four hours, the time it took for her parents to arrive from a community hospital several miles away, where her mother delivered the baby. She died within minutes after a respiratory therapist removed the breathing tube.

During my four year NICU career, I don’t recall any incident of initiating life-saving treatment for twenty-two week preemies. The cut off was twenty-four weeks. Many of those babies did well. For several years after they were discharged home, I kept in touch with some of the families and learned that Baby B was in first grade and reading, or Baby C was seven-years-old and playing soccer. It did my heart good to know they were healthy and vibrant children.

Technology has improved over the past thirteen years – if that twenty-three preemie I cared for in 2001 were born today and received aggressive treatment, maybe she’d survive. I’m not suggesting we stop initiating treatment for extremely premature babies, but with technology pushing us harder and further, with no indication in the near future of it breaking down, I wonder to what extent we are willing to let technology dictate? How far are we willing to turn that knob on the ventilator? What if Baby Z ends up with cerebral palsy, and is never able to walk, talk, or feed herself? And then there’s the flip side. When do we say we need to do more, we can’t give up, we have the medicine, the machines, the formula? What if we inject just one more dose of adrenaline? What if we press one more time on Baby Z’s chest? What if we do nothing and regret it?

As a nurse, I ate those kinds of questions for breakfast. But the answers are gray, and that gray only seems to be getting grayer.

Please, feel free to respond, react, reflect.

Once a nurse, always a nurse. For those of you who are retired from nursing, or have left nursing because your back, or psyche, can no longer bear the weight of patients, does this phrase sound familiar? Maybe you’ve changed careers – maybe you’re now a lawyer, or a writer. But you’re still a nurse.

You’re a nurse when your mother calls and says, “My leg has a red spot on it and it’s been itching for three days, what do you think it is?” You wonder if she could possibly think that you have superhero vision and can see through the telephone wires into the red spot. You tell her to stop scratching it, to put some cream on it.

You’re a nurse when a good friend asks you if you would mind telling her alcoholic brother that drinking is bad for his liver and he is at risk for liver cancer. You want to tell her that he probably won’t listen to you any more than he’d listen to family, but you know she’s desperate. You want to tell her you don’t have experience with liver disease, that you’re background in nursing is with babies, and they don’t drink, as far as you know. She says she’ll get you her brother’s phone number, but the next time you get together with her, she forgets it. You’re relieved and careful not to ask how her brother is doing.

You’re a nurse when your sister-in-law asks you what to do about her bee sting. “It’s swollen,” she says. You tell her to put ice on it. And when your mother-in-law complains of a headache, you tell her to put ice on her head. “It decreases blood flow to the area, you say, “it should help the throbbing” You’re sister-in-law, who is in the room at the time, asks, “Is ice your answer to everything?” We laugh. But I think she’s on to something. Maybe ice is the answer. Maybe the next time my mother or father, or my husband or stepchildren ask what they should do for a stubbed toe, a twitching eyelid, or a paper cut, I’ll tell them to put ice on it.

Since “you’re the nurse in the family,” you’re assigned as your father’s health care proxy. He has Alzheimer’s and can no longer make decisions for himself. He requires caregivers to help him bathe, dress, and sometimes eat. His doctors call you for consent to admit him to the hospital when he suffers from pneumonia, or diverticulitis, or a blood clot. You are called upon to decide whether or not your father should have surgery to remove a lesion that might or might not be cancerous. You are asked to weigh the risks and benefits of every medical intervention your father faces. Sometimes you wish you never became a nurse.

But you are a nurse –no amount of ice can change that.