Compassion fatigue and the unvaccinated

“Do you get compassion fatigue when you take care of smokers or patients with obesity or diabetes?”

This was in reply to an article on compassion fatigue I had posted on my Facebook page. The article was written by an exhausted physician caring for unvaccinated COVID-19 patients. My initial reaction was, “Of course not. That’s my job!” But it made me think, why was it that caring for unvaccinated patients seemed so extra depressing? I had never even considered unvaccinated patients similar to other disease processes that I care for routinely.

Medicine is exhausting. Hospital medicine is trying. No matter your specific role, when you work day in and day out in the hospital, you know that the sickest people in our communities are cared for in the hospital. We see the waves and peaks of all diseases year after year. We are required to be up to date on vaccinations if we are exposed and to minimize infecting others. We are tested for TB regularly. When needle sticks occur, we wait for results to determine if we will need to be on prophylactic medications. Will the HIV or Hepatitis test be positive? We see people die due to preventable and unpreventable diseases, deal with death regularly. There are not many jobs that deal with death regularly. I signed up for this, and I do what I do to help people and hope to make a difference.

Treating a disease with no cure when you really think about it can be near traumatic. Treating a preventable condition can be exhausting, but this is what we do. We educate, we counsel, and when the advice is cast aside, and complications ensue, we lend a hand to help mend the disastrous repercussions. Our compassion does not usually fatigue, and when it does, we find a way to recharge and persevere because our communities depend on us.

Before the COVID-19 vaccine, it seems we were eagerly awaiting the vaccine’s arrival. The vaccine would help prevent the uprooting hurricane that is a severe COVID-19 infection. After months and months of counseling patients and friends, the contrary reception to the vaccine put me in a grief state. As a physician, my job is to help patients make educated decisions about their health. The vaccine has been met with skepticism ironically, even by some that work in health care. Due to vaccine resistance, this last resurgence has impacted unvaccinated patients severely.

This is maybe the root of the compassion fatigue associated with COVID-19. All too often, physicians hold the fate of their patients close to their hearts. We want them to succeed, and when they make poor choices, we feel we have failed them because we did not help them see the importance of quitting smoking, following a diabetic diet, abstaining from alcohol or drugs. COVID-19 is the new preventable illness that we will see people get horribly sick from and worry, where did we fail them? Why did they not listen when we pleaded and begged them to get vaccinated. Not only to protect others but to protect themselves and their families.

The most difficult for me has been seeing and hearing of those in health care declining to get vaccinated. Those that choose to work in health care most typically care about and enjoy working with people. At the root of every story for the journey to becoming a Nurse or Physician, Physician Associate, or Nurse Practitioner lay one core value. The core value is typically a sincere interest in helping others. As a health care worker, you are looked to for guidance by others in your family and community. That is not to say that people will necessarily agree with you. But if you do not get vaccinated, your uncertainty and fear speak volumes. One of the top complaints from community members seems to be, “Even people in health care can’t get on the same page.” Whether you mean to or not, you are actively doing harm. People are basing their choices on their own misguided thinking.

I was initially in denial. I thought people would make better decisions regarding the vaccine if they had all the information, and they just didn’t have all the answers to their questions. Many young nurses are worried about the impact of the vaccine on fertility and pregnancy. They would undoubtedly change their minds after ACOG and SMFM recommended COVID-19 vaccination for pregnant women, but they remain concerned.

Then I became angry. People are caring for patients and are making a choice not to get vaccinated. They think it will never impact them as severely as others. There are simply many people who believe since they never typically get sick that they will be fine if they get sick. Some physicians were and are advising their patients to not get vaccinated. I can’t tell you the number of times I have heard the absurd remarks about not feeling sure the vaccine is reliably safe. This is the largest clinical trial in history. Some say they want more time to ensure the vaccine’s safety. If you or a loved one gets sick and dies, what future will there be to worry about?

Then I bargained. If I spend a certain amount of time discussing concerns with people, they surely will change their minds.

Next came the depression. It was hopeless. Even after presenting the science and answering all the questions, I just could not get unvaccinated patients and friends to see the light.

Finally, I reached an acceptance. The acceptance came after hearing the comments about how you can take vitamin D to prevent COVID and that ivermectin is the hidden secret doctors don’t want you to know about. After seeing comment after ill-informed comment on social media posts about the vaccine. After learning about the conspiracy theories. I learned where people fall, whether in favor or against the idea of the vaccine, is so incredibly political that even those that would ordinarily make good decisions are so impacted by their political persuasion, or the opinions of those they admire, that they have clouded judgment. The resistance to the vaccine is more complex than science and having all the information. There is no possible way to change deep ingrained cultural beliefs about the government that lay beneath the vaccine skepticism.

Patients that choose to remain unvaccinated with the understanding that current data shows doing so will prevent hospitalization, despite their deep-rooted reasons for skepticism, are really no different than those who are noncompliant with their medications, diets, and lifestyle. Accepting my limitations with this complex problem and treating it as I treat all the other difficult to manage pathologies, helps free up my compassion. A burden has been lifted, a weight that has been dragging me down for months. I will not justify their choices or agree with their decisions, but I will care for them and continue to encourage them to do the right thing. To those that have put pressure on themselves to convince people to get vaccinated, please ensure that you are not compromising your own mental health in the process. You can only do your best, take it one day at a time. Some people will never agree with medical recommendations. The best thing we can do is keep offering them the data and hope they eventually choose wisely. When they don’t, and if they fall ill, we will care for them the best we can with what we have, with compassion.