Chicago doctors and nurses, overwhelmed by gun violence, face ‘compassion fatigue’
CHICAGO -- The Northwestern Memorial Hospital's trauma bay was packed, and trauma surgeon Mamta Swaroop desperately needed a private room with a door.
CHICAGO - The Northwestern Memorial Hospital’s trauma bay was packed, and trauma surgeon Mamta Swaroop desperately needed a private room with a door.
She couldn’t find one. So she resorted to a room enclosed only by a curtain and brought in the mother of a young man who was rushed in earlier. Patients chatted from the curtain’s other side. Swaroop knew this wasn’t the ideal way to deliver the news, but in a hospital trying to weather the flood of gunshot victims being wheeled in, there weren’t other options.
Delicately, with the heaviness of someone who’s had dozens of these conversations, Swaroop told the woman that her son was dead. What followed, she said, was a jolting scream. The kind that pierces your bones and never leaves you.
“She fell onto my chest and just kept shrieking and crying. Crying and shrieking,” Swaroop said. “I walked out and looked around. There were so many patients and nurses who had their head down and were wiping their tears. And you could just hear her shrieks, still, down the entire hallway.”
The past 14 months have been Chicago’s most violent in at least two decades. More than 4,300 people were shot in the city in 2016 and more than 760 were killed, according to data collected by the Chicago Tribune. So far this year, at least 915 people have been shot, with the homicide total reaching 166 through mid-April, according to the data.
Nurses and physicians in Chicago’s trauma units say they feel these shootings in their souls. Day after day, they work 12-hour shifts without enough resources to handle the shooting victims. When their shifts end, it isn’t the body disfigurement or the gore that haunts them when they get home. It’s the despair they see. A child who suffers a life-altering head injury. A woman who loses her first-born son.
Over time, some caretakers become numb. Researchers call the condition compassion fatigue –– a mixture of burnout and traumatic stress. Physicians and nurses say they haven’t lost their compassion, but some say they’ve been in situations where they try to isolate their emotions in an attempt to distance themselves from the grief they see each day.
Perhaps that’s because caretakers fear they can’t do enough to save their patients, researchers say, or because the patients they do help are sent right back into the violent neighborhoods they came from.
“It’s devastating to see that over and over. You lose hope. You ask, ‘When is it going to stop?’ And no matter how hard you work and how good you do your job, (the shooting victims) just keep rolling through the door,” said Kate Sheppard, a clinical associate professor at the University of Arizona College of Nursing who studies compassion fatigue.
Several Chicago trauma physicians and nurses said in interviews that burnout and traumatic stress are tough to talk about, not only in the workplace, but also at home with their families. When caretakers go home at the end of their shifts, instead of telling their partners about their experiences, they keep it in. Their stories might be offensive to loved ones, they say, or they might be asked detailed questions they don’t want to answer.
They might turn to self-medication, like alcohol. They develop anxiety and depression.
The biggest problem for trauma physicians and nurses, researchers say, is attrition. Registered nurses who work in critical care had a turnover rate of about 17 percent from 2015 to 2016. Those working in emergency services had a turnover rate of about 19 percent, according to a national report published this year by the Retention Institute at NSI Nursing Solutions.
Although researchers have written about the condition of compassion fatigue in the health care field for years, the term can be misleading, caretakers and researchers agree.
“There isn’t a nurse I’ve met in 35 years who has lost compassion,” Sheppard said. “But they’re emotionally saturated with grief. They cannot afford to care emotionally.”
Many physicians said they accept the stress of their jobs, believing it’s worth it if they can make a difference in their communities. But with the rise in gun violence, that notion has started to dissolve. Physicians have stopped believing their work makes a difference, and the stress of their jobs becomes more wearing, they said.
That’s especially true for pediatricians.
When a child is wheeled into the intensive care unit of Comer Children’s Hospital, home to the only Level 1 pediatric trauma center on Chicago’s South Side, Dr. Catherine Humikowski said it’s easier on her emotions to treat a child who’s more severely injured - whose gunshot wounds have put the child in a medically induced coma.
“That sounds bad, right? That I’d rather take care of a more injured child,” Humikowski said. “If they’re in a coma, I don’t have to see that look.”
The look, she said, is something every trauma doctor or nurse knows. It’s the visible shell-shock of a young child who has a severe injury but isn’t on a breathing machine or ventilator, who’s awake and can see the wires they’re attached to and the strangers exiting and entering the room. The child is in pain but doesn’t fight or fuss, she said. He or she just sits there, silent, emotion wiped from their face.
Physicians, Humikowski said, go into pediatrics to interact with children, to wear little characters on their stethoscopes and create therapeutic spaces. To treat children with gunshot wounds, children in such shock that they won’t make a sound when poked with an IV, is unbearable.
In a hospital that treated 298 injured children in 2016, 53 of them had gunshot wounds, up from 46 in 2015. With these kinds of numbers, signs of compassion fatigue among hospital staff can surface. When younger children are shot, for example, hospital staff members feel empathetic, Humikowski said. “How could this happen to an innocent child?” they’ll ask.
But staff can be more judgmental with teenagers, a sign of the burnout some suffer after years of treating gunshot victims. They’ll assume teenagers could be involved in gang activity or could have put themselves in a position to be shot. The reasons why a teenager was shot, however, shouldn’t matter and shouldn’t be judged by caretakers, Humikowski said.
“Plenty of teenage boys get shot in the wrong place at the wrong time. Walking home from school or playing on their grandparents’ porch,” she said. “To run out of compassion and place judgment? That’s the worst thing I’ve seen. We lost the ability to see them as children who’ve been injured and are in pain.”
In recent months, Humikowski said she’s found herself acting short with her husband when she gets home from her shift.
“‘Tell me about your day, he’ll ask, and I’ll be like, ‘I can’t,’” she said. “I can’t even begin to bring you into it. What do you talk about if that’s what you’re doing 80 hours a week, and you can’t even talk about it at home because it distresses you so much?”
On a late February morning at Comer, a new resident physician stopped Humikowski in the hall. She was beaming, and gushed about her first days on the job.
“That’s what someone at the beginning of a career in critical care looks like,” Humikowski said when the resident left. “Smiley, excited - that’s how we all started out, right? We wanted to help the sickest kids.”
Less than a week before that conversation, devastating bloodshed had shaken the city. On Feb. 14, two children, including a 2-year-old, died of gunshot wounds as a third clung to life.
Takiya Holmes never regained consciousness after she was shot in the head by a stray bullet while sitting in a parked car with her family in the Parkway Gardens neighborhood. Takiya’s mother, Naikeeia Williams, told everyone to duck when they heard gunfire. When her mother asked if everyone was OK, only 11-year-old Takiya didn’t respond.
Takiya was taken to Comer, and her family spent two days of agony at the hospital while she was on life support. She died early Feb. 14 at the hospital. The third child, 12-year-old Kanari Gentry-Bowers, died Feb. 15.
Humikowski, who directs the intensive care unit, said she responded to the tragedy with sadness but without surprise. Hoping she wouldn’t sound insensitive, she said the reality is that trauma workers are “just used to it.” She related the feeling to that of people’s seemingly gradual insensitivity to mass shootings.
“On some level, are we less shocked by it because we’ve seen it more?” she said. “That’s the scariest thing, that we just get used to it and it becomes the new normal. So you shift what shocks you, and then the box settles around something that seems normal that shouldn’t be normal.
“And that’s what I’ve felt is happening with me in my time here at the ICU.”
It’s partly why, after eight years of practicing at Comer, she’s taking a sabbatical this summer. She wants to spend time with her 3-year-old daughter and come back to her job with the same energy she had when she first began in critical care - an energy necessary to move the needle on the gun violence epidemic, she said.
“Where do you regain your strength? A lot of that comes from time at home. Being together, sharing a meal,” she said. “When all of that feels rushed, it’s like you’re giving out of a tank but not refilling it.”
What feeds burnout and compassion fatigue, researchers say, is physicians and nurses’ tendencies to get wrapped up in caring for others, and, as a result, forget to take care of themselves.
“I can’t go on a break right now because my patient needs me.” “My patient might die.” These are things Sheppard, the Arizona professor, hears often. Caretakers can easily blur the boundaries between their work and their personal life, compromising their wellness. They’ll sometimes berate themselves, too - judging themselves or feeling guilty about not doing enough during a shift to prevent something that was out of their control, Sheppard said.
The healthiest way for caretakers to continue their work in traumatic and high-stress environments is by disconnecting themselves after shifts as much as possible. Pagers and cellphones beep and ring, mirroring the sounds from ICU monitors or IV pumps. Though she understands it’s difficult, Sheppard advises trauma physicians and nurses to completely unplug from electricity for a four hour period every week.
Tifuh Amba, a former trauma nurse who now works as an acute care nurse practitioner at the University of Chicago Medical Center, said she’s still haunted by working with gun violence victims. Amba, lives in South Shore, said she was especially sensitive to the issue, never knowing if a friend or neighbor would come in paralyzed.
Her frustrations with gun violence prompted her to go into the community and try to make an impact there. She’s a member of the Chicago chapter of the National Black Nurses Association, a group of health care workers that educates people on health disparities in the community and encourages people to view gun violence as a disease that can be fixed.
“You want to look at what’s causing these people to resolve to guns. It’s good to consider the psychological or socio-economic underlying factors,” she said. “Why is it happening in certain parts of Chicago? In those certain parts, why is it certain people? I’m not saying there are excuses, but maybe (nurses) can address some of those issues.”
Swaroop, who has been a surgeon at Northwestern’s trauma bay for seven years, said she has not experienced compassion fatigue. But she feels the pain and hurt. The wails of grieving mothers stay with her for years, making it impossible, she said, to ever let go of her compassion.
She said the most immediate way for her to cope with the pain and loss she sees so often is with a bowl of ice cream. But in March 2015, she found a more productive way to overcome the sadness of some of her hospital experiences. She took her medical knowledge and decided to use it to contribute to changing the community and possibly curbing the homicide toll.
In January, she started the Chicago South Side Trauma First Responders Course, where she teaches Chicagoans how to stop the bleeding of gunshot or stabbing victims while maintaining their own safety in dangerous situations. She’s taught three courses so far and has trained more than 52 people.
Swaroop said she knows she can’t change the socioeconomics of Chicago’s high-crime neighborhoods. What she can do, she said, is try to control the number of people pronounced dead on arrival.
That’s her job, she said. To save people. To make sure no one, regardless of whether they’re “good guys or bad guys,” bleeds out and dies.
“If you recognize a problem, you should do something about the problem and you should be the change,” she said. “You should try to do something that you have the ability to do.”