Betterinary Care: Caring About the Caregivers

Heidi Hulon | DVM, CCFP, MHFA

“The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to walk through water without getting wet. This sort of denial is no small matter. The way we deal with loss shapes our capacity to be present in life more than anything else. The way we protect ourselves from loss may be the way in which we distance ourselves from life. We burn out not because we don’t care but because we don’t grieve. We burn out because we’ve allowed our hearts to become so filled with loss that we have no room left to care.”

This is what happens to those of us within the veterinary profession. We care a great deal – that is why we are in this profession. The problem is that we do not grieve. We do not acknowledge our feelings in the moment. We go from appointment to appointment to appointment every day. All the negative, sad, difficult emotions/interactions from each appointment are held onto – “I will deal with that later.” They become our negative emotions. That is why we burn out –because our hearts become so filled with loss/stress/anxiety/ fear, that we have no room left to care about anything. This is empathetic exhaustion.

We go into this profession for purpose. Our purpose is to help and to save lives. We are trained to alleviate the suffering in our patients. However, we are not taught how to alleviate the suffering and loss that we will see in humans – clients and self. It is not just what we see, but what we feel as a result of our interactions. We care. We care a great deal – it is in our job description. What we do not do is grieve or allow ourselves to process what we are emotionally and mentally exposed to. These feelings build up and then weigh us down. Our ability to care is diminished and damaged as a result.

This can affect anyone within the profession – “All of us who attempt to heal the wounds of others will ourselves be wounded; it is, after all, inherent in the relationship.” To care for someone in pain requires you to be vulnerable, to walk through that water and get wet. We have to be careful not to drown in the suffering of others.

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We must grieve to process what we feel. We grieve that which we love.

Emotions are brief experiences that last for micro-moments. Emotions are like waves that rise up on an ocean and then dissipate. Emotions are typically triggered by the perception of our current circumstances. While short-lived, they initiate cascades of other emotions – upward or downward spirals. Positive emotions – these tiny fleeting emotions – drive us towards both flourishing mental and emotional health.

The status of the “water” changes, but do we? Are we adequately prepared to handle what we face daily in our jobs?

“A smooth sea never made a skilled sailor.” – Franklin D. Roosevelt

Why then do we do this? Do you ask yourself that question? You need to be able to answer that question: “I do this because…” Knowing your meaning and purpose in life is the single most predictive factor for well-being. What is your why? What gives meaning and purpose to your life?

Empathy is at the core of who we are as caregivers. It is both an innate quality and a learned skill. Empathy is the capacity to see things from another’s point of view and feel what that person is feeling. This applies to both positive and negative feelings. Empathy can go one of two ways – empathetic distress or empathetic concern. When we only focus on the other and forget our own feelings, empathetic distress occurs. Empathy is what we emotionally receive from another. Empathy can trigger the pain center in our brain.

Once empathy is established, that leads to compassion. Compassion is the deep awareness of the suffering of another coupled with the desire to relieve it. It is both emotion and action. It is being present in an energetic way for someone who is hurt or suffering. It is in our job description. Compassion triggers the reward center in our brain. We feel better when we show compassion to others and to ourselves.

Empathetic exhaustion is defined as ‘the cost of caring.’ The price paid by the caregiver in doing their job. A price that includes our emotional, physical, psychological health, and, sometimes, the ultimate price: a life. Why are we so willing to pay so much to do what we want to do?

The components of empathetic exhaustion are burnout +/traumatic stress (primary and secondary).

Burnout is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. The World Health Organization characterizes it in three dimensions:

1. Feelings of energy depletion or exhaustion

2. Increased mental distance from one's job

3. Feelings of negativism or cynicism related to one's job

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How can you avoid burnout? Here are some ways:

• Work with purpose

• Perform a job analysis and eliminate or delegate unnecessary work

• Give to others

• Take control and actively manage your time

• Get more exercise

• Learn how to manage stress

Traumatic stress is a more significant factor for us. The resulting clinical signs from both look the same. It is the causes that are different. Primary traumatic stress is a trauma, injury, or challenge that occurs to you. Secondary traumatic stress is what you witness/hear about a trauma (the drama of someone else’s trauma). This is what we encounter every day with our patients and clients. You witness their pain, fear, anxiety, stress, regret, and anger. We are “infected” with this secondary traumatic stress.

Our brain’s tendency to seek out and find the bad leads to focus on negative emotions and activation of SNS and the fight/flight reaction. Cumulative SNS activation affects us in significant ways. Being a caregiver puts an incredible amount of burden on our cognitive processes. Allostatic load refers to the cumulative burden of chronic stress and life events. It involves the interaction of different physiological systems at varying degrees of activity. When environmental challenges exceed the individual ability to cope, then allostatic overload ensues. Physiological inflammation is due to infection or injury. It requires more energy from the body and has its own psychology (depression, lack of motivation, isolation, etc.). It turns down the volume on a positive emotional state.

The five pillars of physiologic inflammation occur in psychological inflammation:

• Redness – more reactive, angry

• Heat – more prone to burnout

• Swelling – lose our perspective; situations appear worse than they actually are

• Pain – emotional or mental pain along with physical pain

• Loss of function – we lose our purpose and the ability to do our job well

Mirror neurons, psychological inflammation, negativity bias, and the amygdala hijack all conspire to reframe our reference points for happiness and misery. We become desensitized in our work, meaning it takes more to make us happy and less to make us unhappy. What we found rewarding and inspiring early in our career no longer does the same for us after we experience several negative experiences. The negative sticks to us like Velcro and the positive slides off like Teflon.

Who is at risk for this? Everyone at the hospital is at risk. Everyone who is exposed to the traumatic stress of patients and clients is at risk. Knowing you are at risk is important. This knowledge allows you to do something about it. We address risk factors for diseases in our patients every day so that we can minimize the effects that they have. The same is true for ourselves and empathetic exhaustion.

Empathy is an innate response that allows us to connect with others. It is also a double-edged sword. Those of us who go into caregiving fields have higher levels of empathy. We fight to save others. It is our gift. It allows us to share emotional empathy with those we are taking care of. However, without managing and protecting our feelings (self-awareness & self-care), we give away our empathy and take on the pain of others as our own. We end up falling on our sword and being injured by our good intentions. That’s the ‘cost of caring’ –How often do you willingly fall on your “sword” in the name of caring for others? The ProQOLor Professional Quality of Life Score is the gold standard for diagnosing compassion fatigue/empathetic exhaustion. You can find this at www.proqol.org.

What can we do to improve our well-being?

It starts with redefining what it means to be a caregiver. The giving of care part is easy. There is plenty of training for that. What is lacking is caring about the giver – caring for ourselves. The ethical imperative of self-care. It must be a standard of care for those who give care. Improved self-care is the cornerstone of mitigating the impact of compassion fatigue. There are many ways to promote self-care. It must be accepted and applauded by all.

Regarding well-being, there are eight dimensions to self-care. Setting boundaries, practicing self-care, resiliency, and fulfilling your purpose can help set you up for compassion, satisfaction, and success. Instead of suffering the cost of caring, reap the reward for caring. You were meant for the profession and the profession should be meaningful to you.

Regarding well-being, there are eight dimensions to self-care.

Setting boundaries, practicing self-care, resiliency, and fulfilling your purpose can help set you up for compassion, satisfaction, and success. Instead of suffering the cost of caring, reap the reward for caring. You were meant for the profession and the profession should be meaningful to you.

HEIDI HULON DVM, CCFP, MHFA

A native of Alabama, Dr. Hulon graduated from Auburn University with both her undergraduate degree and DVM. She has practiced in a variety of areas during her career, including small animal practice and shelter medicine. She has been the department chair for a veterinary technology program and a technical veterinarian for Hill’s Pet Nutrition. When possible, she does relief work. Since 2011, Dr. Hulon has been a regional consulting veterinarian for Elanco Animal Health. Her current role is the well-being consulting veterinarian, delivering training focused on wellbeing to veterinary customers across the country. In addition, she teaches a wellness elective to veterinary students at Auburn University’s College of Veterinary Medicine. Dr. Hulon has training in FRANK communication skills, in addition to certifications in insights discovery, compassion fatigue, positive psychology, QPR suicide training, fear-free, the human animal bond, and mental health first aid. Dr. Hulon is very involved in organized veterinary medicine and currently serves on the Alabama VMA Wellbeing, Membership, and Constitution/ Bylaws committees. She is a past president of the Kentucky VMA. When not working, she can be found on the tennis court or attending an Auburn event.