The boundaries of caring and empathy are moving targets

As a life-long dedicated health care provider, caring about those in physical and mental need is always a presumed requirement of the field. You’re ill, I act. You’re hurt, I act. I care enough to help educate about prevention of injury and disease. I’ve sacrificed a great deal of comfort, sleep, and mental energy to care enough to help those in need — even for those who don’t seem to care about themselves.

But in many ways, we seem to be crossing an historical threshold. The long-held virtues of western culture including temperance, delayed gratification, chastity, modesty, thriftiness, kindness, sacrifice and hard work are giving way to just the opposite. Gluttony, rampant immorality, instant gratification, laziness, crudeness, wastefulness, drug abuse, selfishness, envy, and jealousy are now a common denominator of everyday life in much of our culture. With that comes a myriad of health problems: obesity, hypertension, diabetes, kidney failure, STD’s, measles, hepatitis, and many other chronic, disabling diseases. Much like in the movie Wall-E, it appears that we are headed toward a time in which everybody is trapped in a lounge chair, too big to get out. And we no longer seem interested in being part of the effort to prevent transmission of communicable disease; especially those that carry them.

Given that the large majority of our culture is and will continue to be racing down this road to oblivion, the question arises with each passing work day, “Am I still required to care?” and if so, how can I possibly find the empathy to do so? The question arises because it appears too few of the participants in the “let’s destroy our bodies contest” care about their condition enough to make changes. We warn, prod, cajole, encourage, educate, and practically beg people to make lifestyle changes, take part in screening opportunities, and get immunizations, screenings and vaccines — to little avail.

Next office visit, same old, “Thanks, but no thanks, but I will take that pill to fix it.” The cultural coolness in avoiding vaccines and immunizations, keeping weird diet regimens that never work, being drug addicted, avoiding work, or tailgaiting another 5000 calories into my body every Saturday is just too good to pass by. Material wealth and prosperity have become pathways to deadly indulgent and self-gratifying living excesses.

In today’s medicine, when a patient states they have quit smoking for over a year, lost 80 pounds, or been monogamous, a caregiver is almost in disbelief — it seems reason to celebrate. But the counter-effect is that we will then be renewed in our efforts to convert the other 100 patients to such success, only to be dashed by the reality of their resistance. The patient insists that I esteem them highly with commensurate caring, but they do not reflect that same kind of caring about themselves. I am to consider them an equal partner in decisions about their healthcare and outcomes, but in reality I am the unequal partner in their poor outcome. I am to respect their decisions about lifestyle, while they reject my offerings of help.

And I am continually required to be happy to see them, empathize with every poor outcome, and be there for them in time of illness — and perhaps to do it for free. No wonder the boundaries of caring and empathy are moving targets.

Tim Mosher is a paramedic and nurse practitioner student.

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