Compassion Matters! 2024 ABA Presidential Address

About a year ago, I looked after a severely injured woman with the worst facial burns I had ever encountered during my career as a burn surgeon. Over the course of many operations on my patient, I made a great connection with her daughter. I’ll call her daughter, “Sandra.” The burn team and I worked hard. I spoke to Sandra often about her mother’s progress. We had many conversations, and we built a strong bond. Sandra’s mother died from overwhelming sepsis during a week I was off-service, and I heard about it later. I didn’t give it the thought I normally would. Then I forgot about it. About 2 months later, for no apparent reason, in the inexplicable way these things enter one’s mind, I thought of my patient and her daughter Sandra. I was horrified that I had not bothered to call Sandra, this person I had made such a good connection with, even if it was just to express my condolences. How could I have forgotten all about this? It wasn’t like me. With a sudden, sickening realization, I knew I had lacked empathy. Of all the people who should have had empathy in that situation, I should have had empathy because I had walked in Sandra’s shoes before, because, you see, my own father had died of a burn injury a decade ago. My glaring lack of empathy had meant no compassion. Something was wrong. I wasn’t sure if this was compassion fatigue, or burnout, or perhaps a sign that I should quit. Something has changed in the world. The pandemic is over, but its sociologic ill-effects linger. Many of us here today have recently felt burnout and compassion fatigue. Wars and grief and chaos seem to fill the daily news cycle. All of us have had to provide more care with fewer resources. Our jobs seem more difficult than ever before. Around that same time, I came across an article that directed me to The New York City Covid-19 Oral History Narrative. One quote from that narrative really worried me: “I used to think that people would come together to take care of one another, and I don’t think that anymore.”1 This was too close to home, and way too close to my story about Sandra and her mom. We are in a state of anomie, a term Émile Durkheim, the father of modern sociology coined over a hundred years ago, to mean normlessness. Not a new normal, but no normal. It is a time of compassion fatigue, or compassion erosion, or loss of compassion, or burnout, or call it what you will, but you know it, and you have seen it. Sometimes, things happen for a reason. Around the same time of my realization of my own lack of compassion toward Sandra, the leadership of the American Burn Association (ABA) identified our organization’s core values. One of those values is compassion, and it stood out like a beacon beside the others. It took on new meaning for me, and I began to think about compassion frequently. Amidst the chaos of the current times, compassion struck me as the most important value to consider and embrace, and that is why I decided to talk about it today. Many members of this organization also think compassion is important. During her regional ABA speeches, ABA Past President Ingrid Parry asked her audiences to name the one value they thought was the most important gift that could be offered to the burn community. She then created word clouds from the electronically submitted words, and the word that was always most prominent was compassion. In the Northeast, in the Midwest, in the South and perhaps not unexpectedly, even up in good old Canada, compassion seems to matter to all of you, too (Figure 1). Word Cloud Created by the Audience’s Response at an ABA Regional Meeting, When Asked “What is the Most Important Gift That Can be Offered to the Burn Community?” Many of you know me as that “evidence-based guy.” You can substitute the word “geek” for guy if you wish. Yes, it’s true, I love to evaluate, scrutinize, and grade the quality of scientific evidence, whether it’s for a Clinical Practice Guideline, a pro-con debate or a scientific review article. But I also love to tell stories, especially the stories of our burn care providers, our patients, and our burn survivors. In other words, the very community I am speaking to this morning. Master storyteller and Author Mark Yaconelli taught me that stories are important because we listen to them, we learn from them, and we remember them.2 Stories can save us, too. And so, today, I want to tell you about compassion and why I think it’s so important right now, using both data and stories. Let’s start with empathy and compassion. These words are used interchangeably but they mean very different things. Empathy is when you feel the discomfort or suffering another person feels. It is the figurative act of walking in another person’s shoes. It’s not sympathy; it’s understanding. Compassion, on the other hand, is the emotional response that leads to an action to help and relieve the suffering of that person. Empathy drives compassion, but compassion is always about taking action to relieve the suffering you feel when you are empathetic.3 I think this story about 2 burn survivors will illustrate the difference: Cpl. Ralph Walker, of the Canadian Armed Forces returned from his tour of duty in Afghanistan without a scratch. Two weeks after returning home he sustained third-degree burns to 70% of his body when a propane leak exploded his hunting cabin. His recovery was slowed by bilateral foot drops, which he lives with to this day. John is a long-haul trucker who survived 80% TBSA third-degree burns when he was immersed in hot tar up to his neck when his tanker truck rolled over. As many burn survivors often do, Ralph and John formed a deep connection and here’s what Ralph recently told me: “While I was still in hospital, another burn survivor I met understood what I was going through, and it gave me perspective and strength. So, when I helped John, it wasn’t out of sympathy, it was because I understood.” That is Empathy. Ralph spent many hours with John, but he spent more time on one thing than anything else: helping John navigate the problem of his own bilateral foot drops. Ralph of course, had literally walked in those same AFO splints and shoes! This picture before you speaks a thousand words. There is Ralph in living color, gowned up, gloves on, and bent over, helping John put on his AFO splints (Figure 2). Compassion in Action! Ralph (Right), Helping John Apply an AFO Splint. Photo Credit and With Permission of Steve Russell (Photographer), and The Toronto Star. That’s compassion in action, and it mattered. I want you to take a moment to think about the ABA’s mission statement: Improving the lives of everyone affected by burn injury. Our very mission statement is all about performing compassionate actions! Mission statements do matter. Let’s take a moment to talk about compassion fatigue because I think it might be the elephant in the room. Perhaps that’s what I had experienced with Sandra. Compassion Fatigue is when a provider experiences emotional withdrawal, along with physical and mental exhaustion. It can be a feature of burnout and it always involves depersonalization: the inability to make a personal human connection with a patient. It may arise because of prolonged and continuous intense contact with patients, or distress that can arise from ever-increasing demands of providing health care with diminishing physical and human resources.4 No understatement: there is a compassion crisis in health care today. A PubMed search for compassion fatigue yields just under 2000 results, most within the past decade. The National Academy of Science and Medicine and The Office of the Surgeon General identified healthcare worker burnout and compassion fatigue as some of the most critical threats to healthcare today.5,6 What should concern everyone in this room, is that our patients already know this. Nearly half of patients say compassionate care is missing.7 There are consequences to compassion fatigue. Quality of care and patient safety are reduced while healthcare worker absenteeism and turnover increase. Burn nurses form the largest member group of the ABA and they are the heart and backbone of our burn care teams. I want to spend a few moments speaking to our Association’s burn nurses specifically. If you are not a burn nurse, I’d like you to try and take a walk in their shoes for a few minutes. Burn nurses: These are particularly difficult times for you. You have seen many of your trusted and senior colleagues leave the profession during and after the pandemic. You all face staff shortages, increasing workloads, and diminishing resources. The cost of caring under these adverse conditions is compassion fatigue, which is harmful to your emotional and physical health and well-being, your sense of job satisfaction, and it is harmful to the central tenet of burn nursing: the ability to empathize, and to care for and build trust with your patients. We know compassion fatigue is common in nursing. on the it of nurses in care and It’s in burn nurses and it should come as no that up to of you have felt burnout, emotional and compassion You will remember John, the trucker story I about his years ago, he has and is a I recently asked what worried the most when he was in the burn and this is what he told me. than I his words and the burn nurses here “I always knew there was an of burn nurses who about me, who to me, who there to me, and to for me. This may but the time I was there was the most and time of my (Figure Burn at the Burn to me, there to me, and to for As from the of one of the most important to compassion fatigue is to on and the value and of more than anything I could the gift that is burn and that is why it for this of which you are our largest to talk about compassion today, and to and what you As you also have an in compassionate within your during these difficult that when there is a strong of compassion in the the of burnout and emotional and are burn nurses and colleagues at my worked with for my and here’s their take on the of a of compassion in the burn told me: on the of from my whether it is just a or if just That compassion has me to on I thought I might not be to the same I on the burn I home in most because of the distress I was in my patients. But over time it has the compassion and empathy of my colleagues that has helped me it. 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I could compassion for also help the person who I the scientific that when we feel the in the But when we think or act very different the in our with and It’s the and it to the of and So, there was what I had A from that those to compassion compassion and and to a compassion to help the some time, the that and not too close to patients is to compassion fatigue. It may just be that the is right that we be more and form those and with our patients and our compassion might just be the to I asked a burn at the of what thought of this If I have increasing my time on the burn because that caring and providing compassion is what me, and it seems on the team have had the same Perhaps more important than made today, compassionate may matter most to you, the As the you want to be compassion. If you want to be this time, I’d like to a few and are burn survivors who had the great to and to you for me walk in your you for your stories, and most of for your as I this There are people from the of and for that I’d like to and Ingrid It’s no they are all from the same that’s In your and of you has me and You have and the for me many times over my career and have taught me about what it to be a good I would not be up here without the love and of my but you for here to this with me today. my I am of the and your not so You have taught me to and to the that things always out in the This has a very year for you. I that you know more people and stories in the ABA than most of our you for my and always for me when is out of and helping to always that Compassion If this talk or even just one story today has or even one person in the I will be With I will with a you to the for the and of as your

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