It’s been just a few months since Hurricane Katrina tested the mettle of thousands of volunteers. One month later, Rita happened. Then Stan. Then Wilma. And those were just the hurricanes. And only a few of them.

Volunteer shifts doubled. More shelters opened. Field medical clinics migrated to yet another Ground Zero. Relief workers are still waiting to exhale. Looks like it’s going to be awhile.

Compassion Fatigue is a recognized form of burnout experienced by volunteers, health care professionals, emergency workers those who give themselves fully to the needy and helpless—to the detriment of themselves. Most often, compassion fatigue occurs when catastrophe drags volunteers into utter exhaustion or when the sheer magnitude of human suffering emotionally drowns the volunteer.

The new reality seems to be, not if, but when the next crisis strikes. So, we had better catch our second wind. Here’s how.

The Guilt Trap

I didn’t do enough.
I did enough, but not long enough.
I saved a life—but only one.

“Guilt is useful, in appropriate doses. It serves as a reminder, an alarm bell that goes off to alert you of something you ought to be doing,” says Dr. Patricia Averill, associate professor of psychiatry at The University of Texas Medical School at Houston.

When your guilt is disproportionate to your role, it becomes paralyzing and intrusive, in the case of volunteer work.

Say to yourself:

1. I can do a small piece, but I can’t do all of it.
2. Even when I was working back-to-back shifts, I wasn’t solving the problem.
3. I can’t accomplish it all, so I might as well do what I can do.
4. As much as I’d like to believe that I am capable of saving everyone, I’m just not that powerful.
5. Buying diapers for a shelter seems so small a contribution. But not to the young mother who desperately needs diapers.
6. I am not so essential that the world cannot turn without me tonight. I can be replaced if I need a break.
7. The best way to honor those I have been caring for is to appreciate what I have: my home, my family, my job, my health. To have guilt because I am not ill, displaced or homeless dishonors those who have lost so much.
8. Remember the age-old advice: I am of no good to anyone if I can’t take care of myself, first.
9. If that doesn’t hit home, try this one: why would someone want me to take care of them when I don’t like myself enough to do the same?
10. And finally: If I must put myself on a guilt trip, let me look at the guilt I’ll have of never being home. (Now there’s useful guilt.)

If you find yourself feeling guilty because you want your own routine to return to normal, let yourself off the hook. That’s human and expected. If you find yourself losing empathy, growing cynical toward the very people you’re trying to help, it is time for a break. Take it.

Find Balance

Balance. We hear it preached so often, it becomes cliché, background noise. Yet, like homeostasis, the ultimate microcosm, we must find it in our lives or we will die. It is that simple. If even thinking about striking a healthy balance between serving others and preserving yourself gives you a panic attack, fill this prescription, Averill says:

1. Write down what you have done that day in a log: for instance, how many patients you saw in your normal day; how many hours you spent working a shelter; how long you spent with your children; your spouse; how many meals you ate; bills you paid; hours you slept.
2. Then, add up what you should have done and what you didn’t do.
3. Then you can start prioritizing, using a real ledger sheet.
4. You might find big debits in the family column, or the personal health line item. This may be an area where you can borrow hours elsewhere.
5. The idea is to find balance in your life between what you need to do and what you feel you need to do—very different realities.

Compartmentalize: Using the Worry Chair

(When you can’t check your volunteer work at the door)

Anyone who has raised children knows about the “time-out” chair.
The Worry “chair” is the opposite of that. People who have a tendency to obsess about a thought as if it’s on a continuous feedback loop must learn to compartmentalize their worries so that they don’t interfere with life.

1. Find a place in your home or office that you rarely occupy. It can be the other side of your desk or an occasional chair.
2. OR: set aside a particular time of day, say 3:00 P.M. to 3:20 P.M. Keep this appointment with yourself—make it as important as a client, a patient, a child’s reading time.
3. Now, let it pour out of you, all the worry, guilt, what-ifs, if-onlys. Hold nothing back. Imagine every possible scenario that intrudes on you day and night and funnel it into that 20-minute period.
4. When the bell goes off, when you leave that “chair”—real or metaphoric, you are done, finished until your next appointment with yourself.
5. When you’re tempted to let those thoughts crawl across your mind, remind yourself that you have 20 minutes to address them—tomorrow.

Rescuing the Rescuers

Recognition that our health care workers are just as vulnerable to critical stress as the rest of us might head off burnout. Even in the absence of catastrophic events, physicians and nurses are seeking early retirement more often and at younger ages.

Managed health care, mountainous paperwork, a litigious environment, the pressure to see twice as many patients in half the time are robbing health professionals of their original “calling.”

Add a national disaster to the mix, and the best of our Samaritans may need rescue.

Yet, also on the rise are programs such as stress management, cognitive therapy, “renewal” seminars, and relaxation techniques that are making their way into mainstream medicine—not just for patients, but for the healers.

Dr. Robert Guynn, chairman of the medical school’s Department of Psychiatry and Behavioral Sciences urges health professionals and those in high-stress relief work to find a stress management system that works for them. “Different techniques work for different personality types. ‘Knowing thyself’ is the first step.”

Cognitive Techniques: Know Thyself

This approach centers on self awareness, becoming cognizant of how you respond to stress. The self-conversation would go like this:

When I’m stressed:

• I get crabby, lash out, yell at the traffic, the dog.
• Or, I may tend to have obsessive, repetitive thoughts—intrusive worries that run in my head on an endless loop. The harder I try to push them away, the faster they come.
• I may have overly negative thoughts: This disaster, this shift, this workload will never end. I’ll never be able to finish, to do a good-enough job. I might as well quit.
• Or, I become physically ill with headaches, body aches, and stomach pain. I feel like I’m walking through quicksand. My blood pressure skyrockets; I can’t get to sleep, or worse, I can’t stay asleep.

“Knowing how you react to stress, without judging it, allows you to change your response. You can consciously restructure your approach,” Guynn says. “At calmer times, we can pay attention to the triggers that set us off and have techniques in place to ward off destructive or counterproductive behaviors.”

Talk

“What we see in the field can be horrific. It’s often tough to shake those images,” says Dr. Richard Bradley, associate professor of emergency medicine at UT Medical School, whose most recent deployment was to New Orleans performing emergency medicine and search and rescue. “And, sometimes the best thing I can do for me is to talk about it with someone who has been where I’ve been, seen what I’ve seen.”

Professional “renewal” groups are springing up around the country in many academic settings. The UT John P. McGovern, M.D. Center for Health, Humanities and the Human Spirit fosters just such a program, where health professionals can share and shed their burdens in a non-judgmental and supportive atmosphere. “The object is not to solve each other’s problems,” explains Dr. Thomas Cole, director of the McGovern Center, “but simply to listen and be present with another colleague’s experiences. At the end of an hour of quiet reflection with those whom you’ve grown to trust, there’s a sense of regained balance, of ‘renewal.’ If we don’t find the right balance between self-care and care for others, we can slip into fantasies of heroism or martyrdom which can be harmful to ourselves, our colleagues and families, and those we care for. ”

Preparedness: Antidote to Stress

(and there will be a next time)

Working non-stop double shifts during Katrina and Rita would deplete any volunteer to the point of meltdown, but, what made it worse was “we also were doing it without a plan already on the shelf that we could pull off, open up and put in place,” says Robert Guynn.

“In the initial stages, each shift was starting from scratch—from creating patient records to simply lining up instruments and supplies. There was no consistency, which is essential in patient triage and follow-up.”

Volunteers worked out the kinks; medical personnel adapted to the chaos, climbing huge learning curves. “Next time we will have an equation: five emergency physicians, four nurses per ‘x’ number of patients per shift. We will still be tired, but we can put our energies to proper use,” he says.

Coming up with “The Plan” is a bit like writing a science fiction script. We feel foolish and certainly helpless while we’re pitching scenarios. “Yet, we now know that we must have a plan for the absolute worst case – a total loss of the local governmental infrastructure,” Bradley says. “I think every major city should have a plan to activate a temporary alternate seat of government. This alternate command post should be located a safe distance – probably several hundred miles – away from the city. If these officials could not reestablish contact with the local chief executive after a disaster, they could take charge and begin to initiate requests for relief and emergency resources.”

Bradley calculates that if every major city had a plan for facing such a worst-case scenario, “99.9 percent of the strategies would never be used, but the one time in a thousand when it is needed, the plan could save hundreds of lives and prevent unnecessary suffering.”

UPDATED: 11-21-2005

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