At my recent CPSP meeting I presented this verbatim and got some new insights from the group. I’m going to shorten it a bit just to make it easier to read.

This happened quite some time ago and when my colleagues asked why I brought it up I responded that it deals with things that I still deal with today: self-care, tiredness, and burnout.

The patient in this visit, Mrs. S, is 67 years old and has been on hospice now for a few months. She has a history of alcoholism and is on hospice for chronic pain and malnutrition. She is extremely thin and emaciated even though she eats fairly well. She smokes regularly 3-4 times a day. She is a widow and has children but they are not involved with her and she does not want them contacted. Mrs. S is Roman Catholic but has not attended church in some time. She maintains her own prayer practices and she says that she finds these comforting. She almost always presents herself as happy and content unless she is in pain, and even then she tends to minimize her pain. Her pain is regularly 8 out of 10. She is very friendly but not always open regarding her own feelings, family and past. She tends to use humor to divert attention and make light of her situation. She is frequently in bed as this is most comfortable for her.

After some initial chit-chat (I’m exerpting main points)…

C8: So how’s you’re back been? Better or worse or about the same.
P8: No, about the same.
C9: About the same? Just not a good day today.
P9: eh..
C10: eh…
P10: (pause) I’m not complaining too much. Stick around though.
C11: You’re not too much of a complainer though.
P11: Seems like I’m always complaining.

We had not discussed this “complaining” before and I was surprised to hear that she felt this way. This is a verbal expression of her inner self-assessment. She expresses the feeling that she is a bad person who should not annoy others with her problems, although she does not use these words. I don’t know where this came from in her past, but it is probably linked with her past alcoholism and estrangement from her family. I thought for a while about investigating where these ideas came from but I did not feel that she would be open to talking about them. I also felt that this may be going to deep for her right now and would shut down communication.

P17: I feel like I’m always complaining.
C18: mm…
P18: But nobody wants to listen to you
C19: Well-
P19: They can’t help you so what’s the point?
C20: Well what do you see as complaining? If someone’s complaining to you what does that sound like or what are they doing?
P20: Well they’re in pain or not happy…and I try to be sympathetic or help if I can but…
C21: Ok, well I wouldn’t even necessarily call that complaining. I would just say that’s saying something’s wrong. And I think you’re always allowed to say when something’s wrong.
P21: Well that’s complaining
C22: When I think of complaining I think of someone just moaning and groaning and trying to get attention for themselves. And I’ve never seen you as someone trying to get attention for themselves.
P22: Well that’s different.

I did want to challenge her assumptions about complaining, which led to challenging assumptions about herself. This also led to a discussion about helping others when you feel that there’s little that you can do to help.

C30: Yeah that is a pain in the neck when you do have someone that just kinda talks about their problems and there’s nothing you can do about them.
P30: yeah, you wish you could help them but you can’t
C31: M-hm (long pause)
P31: It’s like going to the doctor, you have someone who has all these problems and you try to help them and they come back a week or so later still with the same problems
C32: yeah
P32: and you start all over again
C33: Sometimes in a situation like that you can feel good when you can help someone
P33: good point
C34: But then when you have someone that you can’t fix it or do what they need to do to get better you get frustrated and angry
P34: right

It was here that I started to realize that this conversation was as much about me as it was about her. I started feeling depressed and defeated. This was actually where I felt with her: talking about problems without being able to solve them. I had not expected to hit the chord that I had of my own frustration and tiredness linked to helping others. I found helping her get to her feelings of frustration, sadness, and depression touched the same feelings in me. I felt that I moved at one point from an outward-looking stance to an inward-looking one, and this bothered me a bit. I felt it for a time but had to challenge myself not to sit down and become the counselee. I was able to recognize this and bring the focus back to her. After talking about being able to listen as a means of helping, as well as recognizing her own ability to help others, we closed.

C49: Take care of yourself. Find someone to be nice to.
P49: Do I have to?
C50: Yes that’s your assignment.
P50: Well I’ll look in the mirror
C51: There you go – you look in the mirror
P51: and I’ll be nice to the person in the mirror
C52: and you’ll be nice to the person in the mirror. That sounds like a good plan.

I felt really happy that she recognized herself as someone she can be nice to. She saw herself perhaps still as a “complainer” but also as one worthy of receiving care. That was a milestone in my opinion.

The emotional pain that this touched in me is something that I have been dealing with for some time and continue to deal with. Themes of tiredness, sadness and frustration linked to being highly critical of myself have come up in prior CPE units and this encounter brought them up as well. Self care has always been difficult for me, and this encounter shows that it is still a work in progress. I find myself to also be one who should not complain because, as Mrs. S said, “…what’s the point?”. I feel that few understand where I am coming from, little that others can do to help, and few who are even able to listen to what I say. Furthermore, I find that I often have trouble even expressing what’s going on emotionally when I’m depressed or frustrated. I realize that the same things I told Mrs S about being worthy of care, that listening is sometimes good enough, and to be kind to myself are all things I need to tell myself as well on a daily basis.

Mrs. S died a few months after this visit.

The group hit on something right off the bat: “are you burned out?” I expected the question as that was obviously where this was going, and replied that I wasn’t right now but had been burned out. I had burned out several times actually. I said that when I do I try and see what I could have done better, pick myself up and keep on going. The hard part is that I don’t always act on that “what I could have done better” part. It’s very easy to repeat mistakes expecting things to go differently just because of time and context. When asked what I do to keep from burning out, I replied “that’s why I’m here.”