Hektoen International

A Journal of Medical Humanities

Balancing empathy

Nora Salisbury
Vancouver, BC, Canada


Street art in Vancouver’s downtown eastside. Photo by Lee Gangbar.

I almost fainted on my first clinical day in nursing school. I was invited to watch a catheter insertion. While my gut reaction was to completely avoid it, I knew that as a new student nurse I was supposed to be excited about these kinds of opportunities. Watching the procedure I followed all the tips I had heard about, shifting my weight from side to side, clenching my muscles, forcing circulation. But when the procedure was almost finished my vision became spotty and I knew I was going down. I fled the room, still wearing my isolation gown, and found a chair to sit in before I completely blacked out. Sounds echoed around me as sweat poured down my face. I tried to focus on breathing as my vision slowly cleared to reveal my nursing instructor and colleagues staring at me, concerned. I am sure I was as white as a sheet.

In that moment I thought my nursing career was over. But luckily I had a supportive instructor and the will to push forward (or rather, the fear of embarrassment of giving up on yet another career path). I made a plan with my instructor to gain more exposure and ensure that I was always well hydrated and nourished. That semester passed quickly with a steep learning curve. While I did not insert any catheters myself, I was able to make it through without another incident.

The second time I almost fainted was watching a C-section for the first time. The moment the woman started receiving a spinal block I felt the sweat dripping down my back and weakness in my legs. In what I hoped was a casual manner, I found a stool and sat in the corner, placed my elbow on a shelf and my head in my hand. From then on, I focused all my energy on simply staying conscious. The last thing I wanted was to rush out of the room and be “that nurse.” My eyes were open but I was only semi-aware of what was going on around me. I only later found out that there were concerns about getting the baby out safely. The tension that had filled the room in those moments went completely over my semi-conscious head.

After that experience I knew this was something I had to work through. My colleague revealed that she had gone through the same issue and had overcome it through counseling. Through talking with others and doing my own research I found a solution that worked. What I eventually learned was that my problem was experiencing too much empathy. Instead of being focused on the nursing tasks at hand, I was imagining all of the pain and discomfort my patients might be feeling. That first catheter insertion was absolutely horrible to watch. As the nurse was explaining the procedure to me, she did not utter a single word to the ninety-something-year-old woman. She did not tell her what we were about to do, or warn her of any coming discomfort. Instead of focusing on learning the procedure I was focused on the poor woman’s face. I could not imagine that kind of violation, and it made me seriously question the career I was embarking on.

Watching the second woman get prepared for her C-section, I was struck by the terrifying length of the needle and the digging motions as the anesthesiologist changed its angle multiple times while giving the spinal block. Again, I imagined how I would feel with something that size inching towards my spinal cord, surrounded by strangers, likely scared and exhausted from a long, failed attempt at a vaginal delivery.

I have always been an “overly sensitive” individual. I care a lot about others, and am deeply impacted by art and literature. Stories about mental illness and addiction especially affected me, and are in part what led me to nursing in the first place. Once I knew the trigger of my vasovagal response, I taught myself to take a step back. I focused on technique and procedure rather than a patient’s fears, or imagined fears. Watching my second C-section I kept telling myself how happy this occasion was, and how excited the new parents must be. And it worked! I watched with interest the entire time, through the multiple layers of tissue and the first moments of life.

Luckily, I made it through nursing school and various medical and surgical rotations without another near fainting incident. I now work in mental health and addictions, but I still have to watch myself at times. As a new graduate I remember watching a colleague help a client find a vein at a prescription heroin clinic. We did not learn IV insertion in school so I watched with interest, hoping to learn tricks for finding difficult veins. That is, until I asked the client if it hurt. She described the sensation of the needle when it is just outside of the vein. Once again, I was set off. I casually went to find water and a seat, reminding myself once again not to think too much about other people’s pain.

I know I am not the only one who has to control or dull my empathy in order to be a successful nurse. Working in the downtown eastside of Vancouver, Canada’s poorest urban postal code and the epicenter of the fentanyl epidemic in Canada, we see loss every day. Loss of clients, their friends, fathers, mothers, sons, and daughters. We each have to learn to deal with that in our own way.

The danger is in shutting ourselves down too much. To start going through the motions, focused on the tasks and ignoring the connections. To start seeing patients as objects, removing the humanity. In different rotations and casual jobs I have seen horrible judgment, stereotyping, and dismissal on the part of nurses and other clinicians. I cannot help but wonder if this detachment started out as self-protection. I learned that if I empathized too much with someone’s pain I would overwhelm my system and trigger a vasovagal response. What we as healthcare workers see everyday could so easily overwhelm a person, maybe it is easier for some to simply disconnect.

Listening to patient and client stories through writing, film, or artwork is a great way to combat this disconnection. In Vancouver’s downtown eastside, where hundreds die from overdose every year, murals decorate alleyways, honoring those lost and warning of the dangers of fentanyl. There are many creative projects in the neighborhood that have resulted in books, plays, and artwork depicting the struggles and the heart of this neighborhood and its people, who are often labeled as “addicts” or “drug-seekers.” Paying attention to these stories, as well as the daily stories we hear from our patients, can hopefully shift us from seeing the patient and the task, or worse yet, the label, to seeing the person.



NORA SALISBURY is a Registered Nurse working in mental health and addictions in both Vancouver, BC and in Nunavut, Canada. She holds a Bachelor of Arts and a Bachelor of Science in Nursing from the University of British Columbia, and is currently working on her Masters in Psychiatric Nursing at Brandon University. Prior to working in nursing, Nora worked at an independent book publisher and edited books for young adults.


Spring 2019   |   Sections  |  Nursing

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