Burnout and Compassion Fatigue
Nearly two weeks ago, our funeral home was notified of the death of a 47-year-old woman named Diane (both the name and circumstances have been changed to protect privacy). After talking with Diane’s daughter, I scheduled the family to come into the funeral home the following day at 2 PM to make funeral arrangements. On cue, Diane’s husband, mother and two high school-aged daughters were standing at our funeral home’s porch at 2 PM waiting for me to open the door.
Her family was exhausted. I could see it in their faces. As I would come to find out, Diane’s aneurysm was unexpected and sudden. She was standing in the doorway of her home, told her husband she felt weird and collapsed immediately after. The EMTs kept her alive and for a few days and many more tests, they all sat vigilantly by her hospital bed waiting to find out if this was her end or the beginning of a long recovery process. After they received their answer, they were also by her side when the ventilator was removed.
When I meet with families that are grieving a sudden and tragic death, I try to prepare myself for the trauma and pain I’m going to witness. Secondary trauma is what EMTs, ER staff, police, and, yes, death care workers experience when we step into someone else’s tragedy. Secondary trauma is never as intense as it is for primary recipients, but over time secondary trauma can build itself into burnout, compassion fatigue, depression, and even PTSD, all of which I and many in my profession hide beneath the suits. Secondary trauma is the quiet trauma held by caregivers like myself. We often minimize our own pain so that we can focus on the pain of others. Unknowingly and unintentionally, that minimization of our own feelings eventually diminishes our ability to care for those who need us.
The day before Diane was removed from her ventilator, the CDC issued their recommendation that gatherings of no more than 50 people should take place. Diane’s funeral arrangements were the first I would make since the CDC’s recommendation and I wasn’t exactly sure how I was going to address that recommendation when many people in my area still believed COVID-19 to be no worse than the flu.
I opened the funeral home’s door and sat them down in our conference area. After I listened to the family tell Diane’s story for over a half an hour, I felt like I had gained enough of their trust to talk about the CDC’s recommendation. I paused. Took a deep breath and said,
“I know you guys have been in the hospital for the last couple of days and you may not have been following the news, but the Coronavirus has become a legitimate public threat. The CDC suggests no public gatherings over 50 people.”
They all looked at me, trying to decide if I was really brazen enough to follow through with my line of thinking.
I continued, “I’m recommending that you have a private service for only your family and intimate friends.”
The reaction on their faces was something I’ve never seen in all my years of serving bereaved families. It was a combination of anger and assertiveness, grief and hopelessness. As I had learned from the stories they had just told me, Diane served in the ladies auxiliary for two local fire companies, she was very involved in her church and helped manage all of her daughters’ sports teams.
“Diane deserves a big sendoff”, her husband responded instinctually. “She was loved by all of us and I need everyone who loved Diane to come together for a funeral.”
I assumed that would be their response and I was prepared to help them have the funeral they wanted. We scheduled it for the following Thursday at Diane’s church. They expected over 500 people to attend the service.
As the days passed leading up to Diane’s funeral, my anxiety grew as I realized the next couple of months will be unlike anything death care workers have seen in our lifetime. It has that same ominous feeling that those of us in Pennsylvania feel when there’s a Nor’easter churning up the coast, leaving high snowdrifts and power outages in its wake. One day the sky is blue, and the sun is bright and the next day the snow is so blinding you can hardly see. You prepare the best you can by buying rock salt, getting the snowplow ready and checking to make sure the generator still works. And then you wait.
Just … wait.
Right now, the COVID-19 Nor’easter is hitting Bergamo, Italy where funeral homes are dealing with five to six times their normal amount of work. They don’t always have room for the bodies. And funerals aren’t even a possibility. There are so many deaths that the obituary section of the Bergamo newspaper has had nine to ten pages compared to their normal one or two. In Spain, the body count is so overwhelming that they’re using an ice rink to help keep the deceased from decomposing.
Soon after the Bergamo reports hit the headlines, people within and without the funeral industry started giving us practical guidance on how we should protect ourselves against COVID-19. The DHS and CISA have labeled death care workers “critical infrastructure workers”. Just as we do for holidays, the middle of the night and any other time death happens, we’ll be prepared to work the entire way through this pandemic.
Yesterday, I pulled out our funeral home’s contract book from 100 years ago. Back then, my great grandfather, James Wilde, was serving about 35 bereaved families a year. That average was consistent until 1918 when the Spanish Influenza tripled the average to exactly 100 deceased persons. At the time, 100 bodies maxed out our funeral home’s capacity, but it didn’t overload it. Today, we serve approximately 300 families each year. If that number is tripled like it was in 1918 we will simply have no place to store 900 bodies. Like Italy and now Spain, we will have to improvise.
Last week I purchased an extra refrigerated storage unit, a new removal cot, and extra body bags. Like that Nor’easter, however, if the snow is too deep, creates too much damage, and our best-made plans become overwhelmed, we always find a way to get through it. Just like those of us in the northeast who have to deal with unpredictable weather, funeral directors are a creative and resilient group of people.
An overwhelming body count isn’t what scares me the most. This is more than one-dimensional preparation. And because our preparation is only one-dimensional, that’s why I say we’re not entirely prepared.
I’ve yet to hear anyone talk about the potential burnout for our industry and for the many others caregivers that will be affected. Burnout can be equally as dangerous and crippling to our health as COVID-19 itself. Many of us are already burnt out and dealing with an unhealthy mental state. I know I myself have dealt with suicidal ideation and major bouts with depression throughout my career. The fact is that caregivers are rarely good at taking care of themselves. We’re like the five-star chef who makes unimaginably good food for her customers but will only allow herself to eat the scraps.
Two days before Diane’s funeral was to take place, her husband called. “I don’t want to, but I’m going to make this funeral private”, he said. “I can’t put the people who loved her at risk. We’re gonna cancel the public service. I don’t want her friends and family to have to choose between honoring Diane and putting their health at risk.” As I listened to him and tried to affirm him, I have to admit that it was hard to hear him grieve over lost grief. It was a foretaste of things to come. We won’t just be witnessing an overwhelming amount of tragic deaths, we’ll be witnessing people who are grieving the loss of communal grieving.
My wife and I have been preparing our eight and two-year-old kids for the potentiality that I could contract COVID-19. I told them that this pandemic will likely affect us, maybe even affect those we love who are at most risk. I told them that Daddy is still working and I will do my best to stay healthy, but I could very well be exposed to the sickness. I told them that they’ll need to be leaders going forward, ready to take on some more house responsibilities in case Daddy has to rest a few days. And just like I’ve enlisted my own children to help me in case I need it, I implore funeral homes to start enlisting capable women and men who can help them because we will need it!
As those of us in funeral service have seen time and again, when things fall apart, people find an untapped capacity for generosity and kindness. That’s what I want from us in death care and health care. The families we work for need the best from us. If we can start a conversation about burnout and self-care now, we can have generosity later. Caregivers can care for others and care for themselves too. We must care for ourselves.
It’s very likely that the funeral industry in the United States will be overwhelmed in the coming months, especially if our leaders continue to be so reluctant to take preventative measures. While the industry might be overwhelmed, I’d like to believe if we can talk about the psychological impact this will have on us now, we can find ways to keep ourselves together. While our facilities may be overwhelmed, I’d like to believe that we don’t have to be.
Anyone else have trouble validating their own pain and problems because “there’s always people who have it worse?” 🙋🏻♂️
So, I’m riding shotgun with @nicwilde while she tries on new jeans at @express. Those of you who have walked through this valley know this particular challenge. I mean, I totally love my wife, even after the 36th pair of jeans we’ve appraised in the trifold mirror. And if I want something other than pure joy, I’m entitled to that feeling even if nearly one billion people in the world are undernourished.
Real talk. I actually love shopping with my wife because she’s lovely and I love spending time with her. Also, it REALLY is hard for me to validate my pain and problems when I constantly see people in more pain than I am. Why do we compare ourselves? Maybe it’s some evolutionary function that has us continually sizing up rivals? I don’t know where it comes from, but I know for a fact that it is hardly ever helpful. Maybe it worked for our evolutionary ancestors, but it doesn’t work for us anymore. It makes us jealous and unhappy and unsatisfied and mean and possessive and inhuman.
I’m starting to allow myself to validate my pain. I know there’s people in more pain than me. Believe me, I know. And there’s a bunch of cliche reasons why I’m taking care of me, like: “in an airplane, put your own mask on first” and “it’s selfless to be selfish.” And all those reasons are good. For me — right now— I’m validating my pain because I know I need to get better. I need to be a better husband, father and funeral director. And I think if I validate my pain, I can be better. Because if I validate my pain, I might be able to go another round of 36 jeans.
Hey, guys. If you’re a part of funeral service and you’ve happened upon some embalmer/funeral director groups on Facebook, you’ve probably found that the content can be helpful as it relates to practice, but the emotional/practical/human support is rarely helpful. In fact, it’s often hurtful.
As in many human service professions, there’s a stigma connected to sharing our personal struggles. If we share our struggles, we’re often told:
“Maybe you’re not cut our for this business.”
“Some of us just aren’t called.”
“You need to learn to control yourself.”
“This business is only for the strong.”
“There’s no such thing as burnout.”
And it’s bull shit. All of it. We are humans helping humans.
If we acknowledge the humanity in ourselves, it frees us to acknowledge the humanity of those we serve.
So I created a funeral service support group. It’s for those connected to funeral service (past, present, or future) and I’m hoping it provides a place where we can share our troubles without feeling shamed.
HERE’S THE LINK: FUNERAL SERVICE SUPPORT GROUP
So, guys. You know what’s okay to do . . . even though it’s hard and slightly weird? It’s okay to tell yourself that you’re doing a good job.
Life is hard. Death is hard. Grief is hard. Death care is hard. Getting out of bed, getting dressed, helping the kids get ready for school, and walking out the door to work isn’t easy. Some days, just getting out bed is a victory (especially after a night call [my selfie is a #nightcallselfie].
Let me speak for a minute to those of you in any kind of human service work (including parenting because that shit is the toughest of human services . . . and, lest I forget, the human service of self-care because the mental, physical, and spiritual health of ourselves is an uphill battle everyday, a steeper uphill battle for those of us with any kind of trauma or sickness). SO EVERYONE IS IN SOME FORM OF HUMAN SERVICE!
If you’re caring for the grieving, for the sick, or for the dead and dying, you’re doing a good job. If you’re caring for your family, kids, parents, relatives or the family you’ve chosen, you’re doing a good job. If you’re caring for yourself and your health and trauma, you’re doing a good job. How do I know? Because you’re here. You’ve made it this far.
But, let’s be honest: I don’t know you. I don’t know what you do. I don’t know your faults and struggles. I don’t know the nuances of your life. BUT YOU KNOW MORE OF YOU THAN ANYBODY.
Of course you have your faults. We all do. Faults are part of learning. Sins are chances for growth. Shit can grow flowers. But stop and look at how far you’re come.
I’m NOT an optimist. And I’ve never been a huge fan of positive self-talk, but I’m also a realist who knows that telling yourself good things usually produces better things. Because self-fulfilling prophecy works.
Today, I told myself that I’m doing a good job. I took a minute to look at the good I’ve done over the past five years (and sometimes that good is just surviving). As we head into the weekend, remind yourself the same. You’ve done good, Love.
The following is a fictitious story based on all too real trends in the funeral industry.
I sit down in Larry’s office and do a quick look around before we start. Framed pictures of his three girls, a couple grandchildren and his wife are standing scattered on his desk. Golf clubs lie in the corner. A giant professionally drawn water color of the “Wellington Funeral Home” hangs on the north wall. And directly behind Larry’s desk a certificate is prominently displayed stating, “The State of New York Board of Funeral Directors hereby Licenses LARRY WELLINGTON to Practice as a Funeral Director.”
That photo, and others, are a couple weeks away from being removed. The “Wellington Funeral Home” had been the last of the family owned funeral homes in this town; that is, until Larry sold it to a corporation. And that’s why I was here. To cover the story for our county newspaper. An economically depressed region, Larry’s business represented one of the few success stories in our area. He was well loved by our town, respected by his business peers and his thundering golf swing had become a tall tale at the local courses.
Larry sat behind his dated metal desk and I in front of it, we know each other well enough that I bypassed the bull and got straight to the point, “Why are you selling?”
“I can’t do it any longer. After 30 years of service, it’s become a business. And I’m done with it.”
“Let’s start from the beginning,” I interrupted. “Why does a 20 year old Larry Wellington decide to become a funeral director?”
“Thirty some years ago my mother died.” Larry told me how his mom – a single mother (his dad was absent all throughout his life) – had been his rock. “She was everything to me” were his exact words. Worked two jobs as long as he could remember and sacrificed everything for Larry – her only child.
“When she died suddenly on that warm July evening – God, I can remember that phone call as clear as day — I had absolutely no idea what to do. Someone suggested that I call what used to be “Thomas Funeral Home” up in Hamilton County. So I called Dale Thomas and he guided me through the whole process of arranging the funeral, settling Mom’s accounts and he would even check up on me months after the funeral was over.”
“About six months after Mom’s death, I had her life savings in my name and I knew what I wanted to do. I wanted to be like Dale Thomas. I wanted to be a funeral director. And I used Mom’s money to go to the McAllister Institute of Funeral Service. I soon met my wife, I graduated McAllister and we moved here – Joan’s hometown – and I started a funeral home with the heart of an angel.”
At this point, Larry became reflective, his face relaxed in a pensive stare. He had been telling me his story like he was reading it out of a book … the facts of his life. And we had reached the point in his story where the facts began to blend with his current reality.
“I started this business with angel’s wings.” He waited, looking at nothing as though he was looking at a vision of himself that only he could see. “After years of being too generous, I’m tired.”
Slowing moving back to a fact teller, Larry explained how his lower prices both helped the success of the start up funeral home and laid the foundation for its demise.
“No professional service charge for children.
If they didn’t have money, I’d work with them.
If there was no insurance policy, I’d trust them.
Before I knew, I had a target on my back, “If you can’t pay, go to Wellingtons.”
At first, I didn’t mind getting beat out of a funeral. Over time — with nearly 7 percent of my customers not paying their bills — it started to wear on me. So, if I didn’t know the family, I’d ask them a litany of questions about payment and money. I then started asking people to pay all the cash advances up front. And even with the unpaid bills, I was still making a sustainable living, but my faith in humanity and my ability to tolerate deception was beginning to reach an unsustainable level.
About a year ago I buried a gentleman in his 50s who died in a car accident. Tragic. Very tragic. I didn’t know anyone in the family … they were from this side of Tioga county. The family – in their distress? – looked me in the eye, told me they had the money for the $10,000 funeral they wanted (real nice Maple casket, the best vault, etc. … they could’ve gone A LOT cheaper) and after the burial I never heard from them again.”
“I lost my wings after that” he said. “Oh, I had been beat before, but this was the one that broke me.”
Moving back to the reality that is, Larry looked at me intensely and said, “I came to a place where I’d been beat — unpaid — by so many people that I was going to have to charge them up front for their funeral. And I couldn’t do that. So I sold it to people who could.”
He continued, “I got in this line of work because I wanted to serve people, but I’ve become too jaded. Too many people are taking advantage of me. And I can’t force myself to take advantage of them.”
And with eyes that begged me for an answer, he asked, “What would you do? What would you have done?”
I didn’t have an answer. We looked at each other for a couple seconds and right before it started to feel awkward he continued, “_____ Funeral Corporation offered me enough for an early retirement and I took it.”
And the tragedy is this: It’s hard enough to run a business in this world. It’s nearly impossible to do so when you’re uncompromisingly generous. And yet, it’s the generous business people that we so desperately need.
Larry will be moving out of his funeral home and a new Funeral Corporation will be moving in. The funeral home name won’t change, but you won’t find Larry in his office. Instead, he tells me, you’ll find him on the greens, creating more tall tales on the local golf course with each long drive.