Vicarious Trauma – When Your Heart Can’t Hold Any More Stories

broken heartMy most recent posts were about compassion fatigue – the first was on recognizing compassion fatigue, and the second was on what to do (or not do) when you are experiencing compassion fatigue. And then you may have noticed, this blog has been quiet for a little over a month. I think I can safely say that I had been experiencing some compassion fatigue myself. And so as I was dealing with life, I did not take time to write. I probably should have. However, as I was doing some research for the last two posts, I came upon some information that really caused me to stop and think. I came across a term that I had not heard before (although apparently it has been around for a while)- “vicarious trauma”.  This term was used as another descriptor for compassion fatigue. At first I thought “No, that just doesn’t sound right. What in the world does that even mean?” But the more I read, the more it made sense. The concept is that trauma or crisis affects more than just those who are personally traumatized.

Think about this – say you have a friend who is going through a divorce, or a terminal illness, or has lost a loved one, or is experiencing some other type of life trauma. If you are close to that person and are walking with them through that difficult time, it is not unexpected that we take on some of their pain. I believe that as humans, that is how we are built. We were not made to carry pain on our own.

Now consider someone who works with people in crisis regularly – a therapist, a police officer, an EMT, a funeral director, a pastor, an healthcare provider. Caregivers in such circumstances understand that we have a tough job. It is not unexpected. However, some cases are particularly tough. Some may trigger an additional emotional response. For instance, my toughest cases are young patients, patients who are my age with children the same age as my children, or patients with lupus (I have similar autoimmune issues). Having one ‘extra difficult case’ is challenging, but with extra support and the realization that perhaps we are experiencing a more intense emotional response than usual, we struggle through.

Vicarious trauma, or compassion fatigue, is the accumulation of sad story upon sad story, crisis upon crisis, trauma upon trauma, until our heart just can’t take anymore. At least that is how it feels to me. Although we are not directly involved in the trauma, we begin to carry their pain, and vicariously experience some of the effects of the crisis or trauma. It can produce not only emotional distress, but physical symptoms as well, similar to PTSD in severe cases.

Sometimes I have some control over the circumstances – I realize that for whatever reason, a certain patient or situation is going to be particularly difficult. If I can identify that, then I can get help to face the challenges. However, sometimes circumstances are out of my control, and before I know it, my heart says, “NO MORE!”  In the past month, I have experienced this to a degree. I have two friends, VERY dear friends, who are going through treatment for breast cancer. My best friend lost her father. I am dealing with issues within my family of origin that I thought were dealt with years ago in therapy. I was hurt very deeply by someone I thought could no longer hurt me in that manner. The hospital that I work at has been very busy, and there have been more than a few heartbreaking family meetings. And these are just the things that I s choosing to share in this public forum.

So what have I done under these circumstances? With my friends who are going through chemo, I have tried to be more present, and help in more practical ways. With my friend who lost her father, I took time off work to be with her and attend his memorial. With my family issues, at first I just withdrew, but that didn’t feel right. So I’ve tried to set some good boundaries, and create a framework to move on in a positive direction. It is a blurry line being feeling safe and withdrawing, telling the truth and striking out when one has been hurt, and trying to be real and authentic while keeping yourself safe. At work, I have tried to make good use of my time, and still maintain contact with my co-workers.(In my position, I am often a ‘lone wolf’, and have to be really purposeful about teaming with others when possible and maintaining communication with my colleagues.) As for the tough family meetings and patient situations, I have tried to debrief with the others involved when possible, and I have also relied on co-workers who were not directly involved for a listening ear, as well as for advice on how I might improve. Lastly, I think my saving grace has been that I leaving for vacation tomorrow, and I have had that to look forward to!

What might I have done differently? I have been a failure at self care. I have been eating horribly. The other day I had red velvet cake and ice cream for breakfast. Not a very productive way to start the day! I have not been exercising regularly – I have been “too busy” after work getting ready for vacation. I have gained back weight that I had previously lost, and of course that does not help my outlook. I have done too much complaining and whining. I think it would have been better if I could have discussed my frustrations in a more objective manner. I really need to improve my ability to ‘reframe’ the situation. And there were times when I knew I was frustrated or short of compassion, and I just moved ahead rather than taking a break or asking for help.

And there it is. This has really been more of a stream of consciousness and a cathartic exercise rather than a helpful article on vicarious trauma or compassion fatigue. But one thing I have learned in life is that part of the reason I have been placed on this earth is to share my crazy, beautiful, chaotic, genuine, messy story so that others can learn from it, or in the very least, so that you know you’re not alone.

If you want to read some truly informative articles about vicarious trauma, you can find information at

And woohoo! Tomorrow, I am off on vacation! You can follow my travels on my other brand new blog, This Beautiful Holy Mess. My husband of almost 30 years and I are taking a road trip from Vancouver, Washington to New Orleans. In July. It should be quite the adventure.

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