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First, aid.
Second, "I am not Super Glue, I am not Super Glue, I am not Super Glue."

Don't turn your head. Keep looking at the bandaged place. That's where the light enters you. --Rumi

Yet another patient tells me of their "therapeutic" use of a Super Glue agent--this time it's mending finger fissures that have formed as a result of excessive handwashing. Dryness has opened slits around cuticles and on tips and there is fear of going to a dermatologist because the questions will start. What are you doing to cause this kind of skin breakdown? How did it get so severe?

The patient cannot speak the truth so it is "acted out":

"I am full of shit. I am nothing but shit. To cope, I disimpact myself at least three to four times a day. When I do this, I am 'better'. I am lovable." Except for the exposed wounds. Thank you, Super Glue. I digress.

We use all kinds of products "off label". (Go here to read interesting uses of duct tape, dental floss and Super Glue while camping.) Regarding topical adhesives, athletes, field medics et al have been known to keep a supply handy for those times when suturing isn't readily available. But before you stock up I encourage you to keep this in mind: there is a safer alternative. In 2001, the Food and Drug Administration approved a similar, antibacterial form of the substance called 2-octyl-cyanoacrylate, which is marketed as Dermabond.

(Note: a smooth single malt scotch is a miracle anesthetic/antiseptic. Apply liberally to open "wounds". And take that any way you want. It's worked on many a battlefield for centuries.) Moving on.

I'm in the midst of doing research on compassion fatigue and being-burned-the-fuck-out and, no, they aren't the same and, no, neither is pretty. I should probably wait until I'm further along in my reading before sharing anything but prolonged apathy, a classic symptom and clearly on my checklist, is preventing this from happening. (See, I'm toast. I've been telling you about those "walk away" fantasies for the past few months...)

In the briefest of nutshells, burn-out is a cluster of symptoms manifesting on the far end of the stress continuum related to work hassles, appears to evolve in stages (what doesn't, developmentally), and is the result of individual coping mechanisms being employed and subsequently overwhelmed. Compassion fatigue, a close cousin, has an added glitch.

Compassion fatigue is a state of tension and preoccupation with the individual or cumulative trauma of patients as manifested in one or more ways including re-experiencing the traumatic event, avoidance of reminders of the event and persistent arousal. Similar to critical incident stress (being traumatized by something actually experienced or seen), compassion fatigue involves therapist absorption of trauma through listening to patient crises. It is akin to secondary post-traumatic stress.

We're not just talking lousy bosses, heavy workloads, impossible expectations and a lacking sense of control. With compassion fatigue, we're talking:

1) high cognitive demands (intense and sustained mental and emotional focusing), 2) difficult treatment choices, 3) iatrogenic concerns (medical community interventions can be a source of trauma as well as its balm), 4) changing patient expectations and assertiveness (I keep telling you, it's a bitch to receive patient resistance, uh, blame, uh, projection), 5) ongoing shifts in insurance regulations and accountability (liability nightmares), 6) intense and repeated highly charged emotional situations, and 7) life and death decisions.

You know, easy stuff. Especially number seven.

I want to share about the various stages of worker burn-out but think I'll save that for another post--it's quite massive. I am certain many will resonate and find it most interesting. Oh yes, most interesting. And distressing. And sad. Maybe a little scary. It was for me, whoo boy.

Yeah, right now that Super Glue is looking pretty good; I might have to reconsider my position. I wonder how (if?) it can help.

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