INTRODUCTION might want to put their companion to sleep,

INTRODUCTION Veterinarians are workers who care for animals of all sizes and species, and they enter veterinary medicine because they enjoy being around and caring for animals. Their ability to do so relies on their compassion for sick and injured pets, so when they experience compassion fatigue, their work ability is affected, along with other aspects of their lives.  Compassion fatigue, also known as secondary-traumatic stress disorder (STSD), is the physical and mental exhaustion of one who has cared for others that are suffering. CF has also “been described as the ‘cost of caring’ for others in emotional and physical pain” as it is a disadvantage of helping others (Mathieu). It “attacks veterinarians’ empathy and compassion for others—likely the very reasons we became veterinary professionals” (Dobbs). Compassion fatigue is one aspect of being in veterinary medicine that many don’t consider, because caring for others simply sounds like a rewarding and fulfilling job without any negative aspects, which is possible if veterinarians take the necessary steps to preventing or overcoming CF. Unfortunately, a large number of veterinary students drop out and countless veterinarians leave the field due to CF, and the lives of vets are also at risk if compassion fatigue is not dealt with. In order to eliminate the lives and jobs lost to STSD, a solution is needed immediately. PROBLEM: COMPASSION FATIGUE CAUSES Generally put, STSD is caused by having compassion, and is “the natural consequence of stress resulting from caring for and helping traumatized or suffering people” but this pertains to caring for sick and injured animals as well (Portnoy). More specifically, compassion fatigue among those in the veterinary field is the result of exposure to traumatic events, such as euthanasia or failed surgeries and/or treatments.  Death of a Patient Animal euthanasia is the act of putting an animal “to sleep”, by first sedating the pet and then injecting sodium pentobarbital into its veins or abdomen (“Euthanasia”). There are a number of reasons that a pet owner might want to put their companion to sleep, such as terminal illness or injury, but some people use it as a way to get rid of their healthy pet so they no longer have to care for it. Although the injection “is the kindest, most compassionate method of euthanizing animals”, the death negatively affects many veterinarians who are responsible for performing this task multiple times a week (“Euthanasia”). The sadness that comes with each euthanasia may consequently lead to compassion fatigue.  It’s particularly stressful for veterinarians when either a pet is suffering due to an injury or illness and the owner refuses to euthanize, or the owner insists that a healthy pet be euthanized because they simply can’t care for the animal any longer. In both of these cases the vet is not allowed to do anything but follow the owner’s request, and it’s a major stressor for veterinarians knowing that they are taking the life of a perfectly healthy animal and there is nothing they can do about it, as they can be fired for denying the request of a client. A buildup of stress and sadness caused by these circumstances are one of many causes responsible for STSD. Failed surgeries or other causes of death of an animal also take a toll on the veterinarian. When the life of a pet is lost, many only consider the feelings of the owner but fail to see that the veterinarian is often affected by the death as well. This is especially true when the veterinarian has become close with the patient and/or client through previous visits, treatments, or surgeries, though they are also affected even if the patient and vet don’t have a bond because simply witnessing a death is enough to take a toll on the veterinarian. Although the death of a patient is extremely difficult for vets to cope with, it’s not only the animal’s fate that is distressing. A veterinarian has, from her own experience, stated that it’s often very painful to witness a grieving owner, where “the owner’s love for their animal and their grief were evident” (“What”).  Witnessing others in pain, whether physical or emotional, leads to us feeling similar pain. This is caused by mirror neurons – which are “the reason why emotions – both negative and positive – are so inexplicably contagious” (psychologytoday.com/ blog/ethical-wisdom/201103/i-feel-your-pain-why). Mirror neurons allow people to feel the feelings of others, so when a veterinarian witnesses an animal in pain/distress or sees an owner grieving a lost pet, the veterinarian experiences the same emotions. This means that not only are vets negatively affected by the death of the patient, but by seeing the owner in pain as well, which altogether provides plenty of factors that contribute to CF. Overall, witnessing death impacts veterinarians daily and is a devastating cause of compassion fatigue. SYMPTOMS When a person is exposed to such trauma on a daily basis, and becomes so involved in the pain and suffering of others, it mentally and physically exhausts them and leads to negative symptoms. Unlike burnout, which is “Cumulative process marked by emotional exhaustion and withdrawal associated with increased workload and institutional stress, NOT trauma-related,” compassion fatigue symptoms begin showing rather quickly (“Compassion”). Symptoms of STSD include depression, insomnia, poor job satisfaction and irritability. Other symptoms are substance abuse, apathy, and difficulty concentrating (“Work and”). Physical symptoms include “sweating, rapid heartbeat, breathing difficulty, aches and pains, dizziness, impaired immune system, headaches, and difficulty falling asleep” (Portnoy). The most concerning symptom, however, is suicidal thoughts. CF ultimately has a massive effect on veterinarians’ home and work lives, and it needs to solved immediately. WHY A SOLUTION IS NEEDED  Finding a solution for compassion fatigue is very urgent, as shown by many worrying statistics. First off, and most concerning, a 2012 study shows that “Vets are also three to four times more likely to take their own lives – significantly more than doctors” (“What”). It was also found that veterinarians have the highest rate of suicides among workers in the US (Lizik). The graph above shows that veterinarians have the highest suicide rate per 100,000 employees than any other profession being at 38.2%, with paramedics being close behind at 35.6%. Such a high job-related suicide rate among veterinarians and veterinary students are obvious indications that a solution is urgently needed to decrease the number of jobs, as well as lives, lost to compassion fatigue. Also, depression among veterinarians is more common than in the general population (“What”). But it doesn’t only affect those already with a job as a veterinarian; a recent study discovered that “a third of veterinary students had experienced depression”, where only 1/8 of the total population has experienced it (“What”). As indicated by how concerning as these statistics are, it’s extremely important that the issue of compassion fatigue is solved to eliminate the loss of veterinarians’ lives. Not only are veterinarians’ personal lives affected by STSD, but their work lives are as well. Compassion fatigue commonly affects the vet’s patient care by impairing his/her cognitive abilities, and as a result “increases the risk of accidents and injuries” on the job which can be fatal during important procedures (Weinstein). Dobbs also claims that veterinarians suffering from CF “make errors, lose respect for clients and patients, and contribute to a toxic work environment as we find it more difficult to care” all which decrease the quality of care for the patient, which may put the pet’s life at risk. Because lives are on the line, it is critical that care for the patient is performed as well as possible by the veterinarian, so a solution for CF is crucial. SOLUTION PREVENTION The first solution to eliminating cases of compassion fatigue is prevention. Prevention of CS can be achieved by setting “emotional boundaries” (“The Cost”). Establishing these boundaries protects veterinarians from becoming too emotionally involved in the patient’s or owner’s pain and will allow them to “avoid under- or over-extending them self” (Stoewen). It is ideal for vets to “remain compassionate, empathetic, and supportive of others without becoming overly involved and taking on another’s pain” (“The Cost”).  Veterinarians can also prevent suffering from CF by educating themselves on the issue, learning what to watch out for and seeking support if they think they may be at risk for compassion fatigue. Another way to prevent risk of CF is for veterinarians to limit themselves. Baranowsky explains that the first phase of STSD is “The Zealot Phase”, where the caretaker is excited about the work and takes on more than he/she can handle. This workload over exhausts the vet early on and prevents him/her from having the ability to feel fulfilled and perform properly throughout the rest of the career. It’s like a race: if the person uses all his/her energy in the first few minutes of the race, he/she will become exhausted and slow down throughout the remainder of the distance. In other words: veterinarians should make sure to pace themselves in order to maintain their enthusiasm, passion and quality of performance for the job. SELF-CARE Another way to avoid suffering from compassion fatigue, as well as other mental health issues, is proper self-care since it’s common among those caring for others’ needs to forget about their own. Self-care includes eating healthy, exercising regularly, getting proper sleep, balancing home and work life, and/or meditating. Also, if a veterinarian feels that CF has caused depression and/or suicidal thoughts, he/she should see a counselor. This will provide a safe, comfortable environment for the veterinarian to express his/her feelings and receive professional advice. It may seem obvious to care for oneself, but it’s common for veterinarians to feel guilty for taking time to themselves. It is completely okay (and necessary!) for those in the helping field to be selfish sometimes – the goal is to achieve balance between caring for others and caring for themselves. It’s important for the veterinarian’s, as well as the patient’s, wellbeing that the vet takes care of him/herself to ensure that compassion fatigue does not become part of the equation.   SPIRITUALITY & RELIGIOSITY  Another possible way veterinarians may cope with compassion fatigue is embracing spirituality and/or religion, for those who are involved in either. Numerous studies show that “those who are more spiritual experience a greater sense of well-being and life satisfaction, cope better with stress, and are less likely to commit suicide” (Simpson). So, for those who are spiritual or religious, embracing either (or both) may be a great option to solve compassion fatigue, as Simpson states that it allows people to cope better “during difficult times”. TRANSFORMING COMPASSION FATIGUE INTO COMPASSION SATISFACTION An additional solution to this issue is transforming compassion fatigue into compassion satisfaction. Compassion satisfaction is essentially the opposite of compassion fatigue: it is pleasure and fulfillment that results from focusing on the positive aspects of a career in helping others. Veterinarians can transform CF into CS by celebrating the “wins” of the job. Instead of focusing on the “stressors”, veterinarians must focus on the “satisfiers”, such as “helping and healing patients, working as a team, and thankful clients” (Dobbs).  Debbie Stoewen states that there are multiple steps to achieving compassion satisfaction, some of which include solutions that have been spoken about above. One step being to maintain a positive outlook. She recommends that when one begins to “blame, whine, vent, or complain”, they should “identify one good thing that’s right about the situation” (Stoewen). This does not mean that veterinarians should not talk about their feelings altogether, as this results in suppressing of emotions and further consequences, but to always keep in mind that they help others and even save lives on a daily basis. Stoewen goes on to say that “when you start identifying things to appreciate, you are more likely to notice things to appreciate”, and               “practicing appreciation creates a self-fulfilling prophecy”.  Veterinarians can also avoid STSD by practicing altruism CS. Altruism is defined by biologists as “any behavior that benefits another individual at a cost or risk to the altruist” (psychologytoday.com/blog/goodness-sake/201610/animal-altruism). As spoken about in a previous paragraph, a few symptoms of compassion fatigue are hopelessness and loss of purpose. However, if veterinarians focus on the number of lives they’ve saved and the number of lives they’ll continue to save, they may realize that they have a purpose. This transformation will allow veterinarians to overcome STSD and enjoy taking care of animals – what they became veterinarians for. HEALTHY GRIEVING The last solution to CF is practicing healthy grieving. Many people don’t grieve properly, or don’t allow themselves to grieve at all, which may consequently lead to the suppressing of emotions. There are 5 steps of grief: denial, anger, bargaining, depression and acceptance. The first step to healthy grieving is allowing time to grieve, instead of rushing the process or ignoring it altogether. Another way for vets to grieve is to reach out to others, such as teammates who are upset by the death of a patient as well. By normalizing the issue, each veterinarian will feel more comfortable talking about his/her feelings about the hardships of the job, allowing him/herself to avoid isolation and bottling up. It is also important for the grieving process that the veterinarian does not feel guilty for enjoying other aspects of his/her life, or for moving on from the loss. Finally, in order to grieve healthily, the veterinarian must practice proper self-care and should especially consider seeing a counselor, which was spoken about above. Going through a healthy grieving process is crucial to eliminating the risk of compassion fatigue among veterinarians.   OUTCOMES Stoewen states that outcomes of these solutions include “improved patient quantity and quality of life . . . Stronger veterinary-client partnerships . . . greater adherence to treatment plans and improved patient healthcare outcomes . . . improved morale and productivity, and happier workplaces” as well as better relationships among coworkers. All of these outcomes are the ultimate goal among people in veterinary medicine and they will lead to better quality of life, job satisfaction, and fulfillment for veterinarians. There are two possible paths for the 5th step of compassion fatigue as told by Baranowsky: either “pathology”, where the vet becomes extremely overwhelmed and eventually leaves the profession or devastatingly takes his/her own life, or “renewal” which is described as “hardiness, resiliency, and transformation”. It is up to veterinarians to solve this issue in pursuance of saving their physical and mental health, as well as their ability to do their job properly and continue saving lives. CONCLUSION We cannot wait for more lives to be taken or jobs to be lost to put a stop to compassion fatigue. The suffering from CF among veterinary professionals is a serious issue that must be solved through prevention, self-care, spirituality and religiosity, transformation, and/or healthy grieving.