compassion fatigue

a while ago i ended up in conversation with a psychologist. she mentioned the danger in her profession of compassion fatigue. the term struck a chord in me. she was referring to people moaning about how tough their lives were when their lives were nothing close to tough. it irritated her and she knew she needed to guard against this. i decided not to even mention to her what my compassion fatigue was like. it might have made her think less of me. i know i did.

he was no more than a common criminal of the south african variety. on that fateful day he decided to rob a small rural supermarket. i suppose he had gotten his hands on a gun and it seemed like the natural thing to do. anyway he entered the store with gun at the ready. he entered the outer door and was in the tiny area of about two meters between the inner and outer doors. just at this moment the owner of the shop was exiting the store and the two found themselves together in this rather cramped space. the owner immediately realised there was something amiss. this might have been due to the fact that he was staring straight down the barrel of a gun. then all hell broke loose.

the criminal didn't say a word. he started blazing away, spraying that tiny space with a hail of deadly lead. the owner dropped instinctively to the ground, drew his own weapon and fired one single shot. when all was tallied at the end, the shopkeeper had come off better. he had been hit in the arm but the damage was minimal. his shot, however had entered the criminal's head on the side just in front of the temple. it had then passed through both eyes and exited on the contralateral side at about the same place. the guy would be blind for life. i reflected that his terrible aim would now be even worse. it would definitely be a problem with his chosen profession.

the other case i thought of was a car thief i once treated. he got shot in the line of duty. he was innocently driving away at high speed in a car he had just liberated from the rightful owner when the police, who were on his tail, shot him twice. the one bullet took out his femoral artery. the other shattered his knee and tibial plateau of the other leg.

to cut to the chase, we cut his leg with the arterial injury off to save his life, he was that far gone. the orthopods stuck an exfix over the knee on the other side. and then he gradually recovered. at about this time i was transferred to orthopaedics so when he developed a pseudoaneurysm of the popliteal artery of his good leg i just heard about it via the grapevine. i also heard that they were going to give it some time before they operated, hoping that...well i don't know what they were hoping actually. anyway safely tucked up in the orthopaedic hospital it was not my problem.

then i learned that the orthopaedic surgeons were going to try to repair the tibia and i was going to be involved. step one was to get the patient down to the orthopaedic hospital from the main hospital. other than the usual administrative frustrations, he was finally loaded into an ambulance and brought down. it was the loading out that proved to be tricky.

as the ambulance drove into the parking area of the orthopaedic hospital the aneurysm burst through the skin and the patient started bleeding all over the place. he was rushed straight into theater and yet still by the time he got there once again he was flirting with death. the vascular surgeons were called and they arrived amazingly quickly. they then sort of looked at the leg for a while. after a few minutes of inaction they pointed out that the muscles of the leg were dead. it seemed that the pseudoaneurysm had gradually decreased the blood supply to the leg and by the time the thing had burst in the parking lot, the leg was already in a bad way. they then instructed us to remove it and left. the orthopaedic surgeon in turn instructed me to remove the leg and then he too left.

as i lopped off the limb i reflected on this twenty something year old who now had to face the challenges of life without a leg to stand on. it seemed sad. but then i realised my own car had been stolen only about a month before and it was not completely impossible that this person could be the very person who had stolen my car. it was the life he had chosen and the risks were part of that life. i struggled to feel sorry for him. besides, i reflected, he would no longer be so fast when running away from cops in the future.

the first time i realised i had compassion fatigue was around intermediates (roughly half way through specialising). i was warn down from cases like the two mentioned above. but there also seemed to be a run of gunshot wounds of criminals that i ended up trying to keep alive at unearthly hours with exams looming. in the end i just seemed to get sick of them and overly sceptical.

then one day i was required to go to some or other awkward social function. at that time my work was so all encompassing i didn't get out much and it showed. i ended us standing away from the normal people and whenever i was forced to speak to one of them, when i looked at them my mind kept on repeating one phrase over and over again.

"fresh meat."

i needed a holiday.