Reflections

To Be Vulnerably Honest

By Denise Kavuma (MD), Uganda

Five years ago, in a moment that felt much like this one, I was surprised by the realisation that I had developed compassion fatigue. That somewhere in my two years of medical practice, I had subconsciously decided to take a step back from empathy. What could possibly lead me to such a drastic step? None other than my old friend trauma, of course! However, I shall start at the beginning.

As a child, I was what some would call emotional, a nuisance, or – as my therapist would later call me – highly sensitive. Now to be fair, I did not choose to be this way. I have always had too many feelings, or so my friends have told me, and they could be right, or I could have a penchant for making friends with assholes – not that those two scenarios are mutually exclusive, mind. My point here is that I was on the path of natural empathy long before I knew what the word meant. This became a problem when I finished med school and had to deal with patients who came in carrying varying levels of despair, hunger, depression, and pain, so much pain. Of course, my experience was nowhere near the dramatics of the “empaths” seen in fiction. That is to say, I would not collapse to the floor, moaning theatrically, because I could feel someone else’s pain. If I’m telling the truth though, it was still a shitshow. After all, what is someone to do when their cup is overflowing with emotions and they are faced with the death of someone in their care?

To the surprise of absolutely no one, that is when depression reared its ugly head. There was no preamble, no blood pact, or ominous chanting. One month I was starting internship and the next, The Darkness was eating me without so much as a “can I take you to dinner first?” Therefore, in order to survive, my brain made an executive decision to suppress my empathy so that I could treat those despairing, hungering, or dying people, without breaking down. The compassion that I had so readily dished out was suddenly lost to me. What I needed then, was empathy from those around me. However, this is when it became quite clear that I did indeed have a knack for making friends with assholes.

In cases of acute anxiety or stress, people often shed an aspect of themselves; hair, fat, their will to live, even their humanity. I shed too and what I lost were friends. I was in the darkest period of my life and I was alone. Small tendrils of my compassion became warped by the depression and I remember thinking to myself that it was okay. I was okay. After all, I was pitiful and not much fun to be around, in that time. I had nothing left to give and it was only fair that my friends leave for greener pastures and for better people. I was empathising with them, I told myself, and they were right. This too was quite traumatic, I would later understand.

I learned from that encounter; boy did I learn! If I wanted to get anything done, I had to do it myself. I had to watch my own back, butter my own bread, and kiss my own ring. Love was not enough; it would never be enough because it did not give respect, or emotional intelligence, or adaptability. What was enough was all that I am. I was enough and dammit, I would repeat that until my subconscious  soaked it in. As the walls around me grew higher, I felt safer. My whole world was finally filled with acceptance and love, because I alone was in it. What a way to live. What a perfect way to exist.

It went wrong somewhere, of course. The problem was that I got complacent; too comfortable in my little bubble. I had not been at war for a long time and therefore I had lost my vigilance. Peace had made me lazy and fat – well, fatter. I wish I could have been hard-core forever but hey, we can’t all be perfect. Therefore, I opened the gates and slowly started letting people in. New friends who were curious about all the darkness surrounding me. People who felt special and wanted the exclusivity of being allowed through the walls. Assholes too, because old habits really are hard to break. They consumed my compassion, attacked my sense of self-worth, pierced me full of holes, and left me screaming in rage and agony. The worst of it was they were unaware of what they were doing. Whatever world they had encountered in my friendship was so foreign to them that they were not sure what all their callous words and neglect were doing to me. They simply could not picture themselves in situations similar to mine. To empathise with me would have been too much.

I had been through these woods before. This darkness was familiar to me and when I finally emerged, I was seated alone in my house, on my 30th, eating a rainbow cake no one wanted to share with me. With this feeling, I was well acquainted. This time though, I would not form walls of iron to cluster myself in. I would not build them until they were so high, they bloated out the sun and left me in my warm darkness. No, I wanted to sit in my open fields and feel the sun on my skin, and the wind in my hair. I wanted to be free with myself and dance as I made my journeys. I wanted to be me, without the corner I had huddled into all my life. So I sat in my fields, danced with the wind, and said “no, thank you,” to every person who asked to join me.

I do not want any more friends.

This is where empathy is tested. Not with the ability to yawn after I do, but with the response I get when I say “you’re nice, but I really don’t want any more friends.” To me, empathy is understanding why I would say that.  It is holding back the misgivings, the yearning to offer me advice, or the need to “fix” me. Far from approval, it is the compassion you give to someone like me who does not believe in a magical creature out there that will offer me just the right level of friendship, if I can only just keep looking. These gates are closed to unicorns and flying pigs alike. To me, empathy is being left alone, when I ask to be.

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