I'm highly-HIGHLY empathic and work in healthcare & social work. I'm suffering from empathy fatigue 💯. I clicked on this video 99% sure that I would hate it. I was dead wrong. I feel like I was just diagnosed. I've just realized that empathy is not my superpower, it's my kryptonite. Time to re-boot & reprogram. Thanks guys.
Catie and the Bo Peeps I'm exactly the same. Too much so in my OT work, too much with my 3 teenaged daughters and then I have NOTHING left for my husband. Not his fault, mine. I need to change things. This video has really helped me.
Same here. I burned out. I felt like I was being fed on by a relentless vampire hoard. That is what working in healthcare felt like to me. No matter how much I gave, it was never enough. It’s an extremely unrewarding environment. Its impossible to want to come to work when feedback is nonstop negative. I turned really negative and toxic. Had nothing in the tank anymore for anyone and a big case of resentment 6 years ago. I’ve started to think about getting back in via temp agency. Maybe it’s doable in fixed three month chunks.
I was very wary of this video going into it. I'm a genetic counselor and empathy is highly valued and highly praised. But in listening to you, the difference between cognitive empathy and emotional empathy is so key. Emotional empathy will certainly be an emotional burden for the caregiver and it also keeps caregivers from caring for their patient: how can you be a support to your patient if you yourself are suffering over their situation? It also takes you away from your family and friends. But cognitive empathy - knowing what the patient's perspective is, what factors are influencing their state of mind and medical decision-making - that is priceless for patient care.
This is well articulated, and much more common than people realize. Superficially one would think that patients want their key decision makers to be emotionally invested. However it is insightful to note that what they really want is the clear thinking of a person who can control emotion and steer the plane home. The hard part comes when the pilot needs to honestly tell a passenger that his plane is going to crash.
many of my co-workers give me a hard time about my lack of empathy. I do have compassion for my patients but, I feel the times I have empathized with a patient/ family it is very draining emotionally and physically.
I had to take a break from PICU after the ICU-death of my father. The reminders were constant and the emotions too raw and I could barely get through my shifts. I spent a year in Newborn nursery, and returned to PICU when I was healed enough to give again. In the meantime one of my former co-workers took her own life by drug-overdose. I am so thankful that the right opportunity came up at the right time for me and I was surrounded by a supportive administration and staff.
This is how I see the semantics. Sympathy= I know what you're going through Empathy= I can understand why you feel that way Compassion= What can I do to make make it better. As a nurse I try to stick with compassion because I can do my job without becoming too emotionally invested
10 years of hospice nursing I burnt out to the point of physical illness. I was very empathetic but every 6 months I would shut down to be able to survive.
I find this interesting because I’m in nursing school, and my nursing school is highly affiliated with the Cleveland Clinic and University Hospitals. And they taught us to NEVER have empathy for patients because it’s a bad thing. In my nursing school they are drilling it into us that empathy is bad, compassion and sympathy is good. “When you’re empathetic you are useless, when you are sympathetic you are useful” is what they always tell me. So I find it strange to hear you say the Cleveland Clinic at one point encouraged empathy. They must have dramatically changed something in the past few years.
An excerpt from a FB post I wrote: if it's life or death, give me the nurses and doctors who are all science and logic. I don't want them seeing me as someone who could be their mother, daughter, sister...I don't want them losing their shit while they're trying to save my life. There's a reason physicians don't treat family members. Depersonalization is a necessary evil for objectivity. So please think before you say to a medical professional, "Imagine if that was your child back there." In order to receive the BEST care that's the last thing you want your medical team thinking about.
I agree, but some of this is more semantic than genuine disagreement. Most people don't necessarily distinguish among all the different words -- empathy, compassion, sympathy -- though I totally agree that TRUE compassion does not "fatigue" because the giver receives and the receiver gives, even in the moment of exchange. The great Tibetan monk (and French PhD in molecular genetics) Mattieu Ricard calls it "empathic distress" -- the one that wears us out. Over-feeling for another renders the would-be helper less effective (and leads to so-called "compassion fatigue"). I can be compassionate toward someone without losing the boundary between their suffering and my emotional response to their suffering. I do them more good by trying to understand their suffering and by non-judgmentally DESIRING THEIR WELLBEING (I like ZDogg's use of "love"). At the Cleveland Clinic, we are working hard to feel just enough to make us act on behalf of the suffering other, to DO whatever we can to relieve it, without over-feeling to the point of paralysis, personal drain or, worse, repugnance. If we see compassion as a source of recharging our own batteries and DOING something -- not just feeling -- everyone benefits. Let's not argue about which word we use -- let's just do it. Rev. Amy Greene, Director of Spiritual Care, Cleveland Clinic
This is so releveant to social work and education. watched it a few years ago when I was still in school and didnt get it - now that I have worked in education and do work in social services I completly get, Having experianced empathy fatigue many times and trying to tune down my empathy (with mixed results). Id say that all helping proffesions - Medicine, education and Social services/welfare are all part of te same tribe of people who experiance warzones worth of tragedy every day. some of us, such as myself, do this work in a literal warzone too. Thanks Zdogg, this video and alot of other videos on the channel are realy helpful - keep up the good work.
I agree with much of what you're saying, however I think there are situations where empathy can actually provide a diagnostic advantage. As a neurologist, I encounter many conditions that patients have difficulty conveying. Many times narrowing my differential diagnoses requires teasing out subtleties that are best achieved through empathy. I think that neurology and psychiatry are the most readily understood applications of empathy as a diagnostic tool, however I think it can be used effectively by other clinicians as well. Even so, using empathy in this way has its limitations and can absolutely lead physicians astray if not appropriately checked.
Thank you so much for this video. I will always keep this in mind. I like how you explained your viewpoint very clearly and with good arguments and I think this can really help a lot of people because it's always good to hear the downside of something considered to be a virtue in healthcare because it's important to hear things from two sides. I know this video will help me as well to be able to become a better healthcare practitioner because I think that if you feel good about your job emotionally, you will be able to help your patients the best. So thank you!
I'm going to be a better Nurse because of you Dr. Z!! Im my second semester of core ADN classes now and I watch you in all my free time!! thank you for sharing your wealth of experience and knowledge with all of us other folk!!
Nail on head! Great point and discussion today Dr ZDogg. I'm currently in medical school and they're so pushing this version of empathy. While well intentioned it becomes virtue signaling and different from true compassion. Again great topic, love the new show
very interesting topic - i have found over the years as a primary care, keeping a distance/preventing empathy helps keep me from burning out as bad, and helps me remain compassionate - kudos
I took care of an elderly former nurse who's children refused to make her a DNR as she was dying. She was coded several times and then put on a ventilator. I could sense she was wanting to just be comfortable and be allowed to die. I spoke with her children 3 times to allow her to be a DNR comfort care and they still refused. I felt so helpless to go 9th what I was sensing from the patient. Finally she passed and the feeling in the room from her was at a peace. I cried because she was finally at peace and no longer suffering. It felt like she was family and I grieved form her fro several weeks. I still went on the care for other patients the remained of the day and felt more compassion for the remaining patients.
I'm just a human (I do have a phd in Dr.Mom) personally, I am paralyzed by my empathy. It is almost an obsession with me. I have paralyzing anxiety..I think it's just because I've been through so much. I wish I wasn't that way. I appreciate compassion, kindness and humor with my doctors but I HOPE they don't feel empathetic for me...that saps the energy from their brain and they might miss something that could save my life!
I'll admit it - I was ready to get on my high horse when I read the title of this video lol. Excellent points - when I'm a student RN & did a placement in palliative care. There was a young girl with a bowel obstruction. I sat with her all night during the night shift, holding her hand while she wailed & moaned in pain. She was from overseas & had no family or friends around. I was beside myself thinking about what she was going through - I wanted to distance myself from patients after that. If you take all your patient's troubles on, you're just going to get burnt out & be a shitty health care provider.
I agree with using your definition of compassion instead of empathy. You need to have the desire to be with and help others in the face of their suffering, but i you can't take that home. You're right, nursing school certainly hammers empathy into our heads. I even got odd looks from my cohort when i said you can't truly care about your patients as in taking on their pain. I think compartmentalization is not talked about enough in school. We spend years busting our ass to learn how to care about others, and very little time learning how to take care of ourselves in the process.
As an empath in the medical field, in the NICU to be exact, I have to agree with you. I struggle with taking on the energies of everyone around me. Emotions are already high on our unit but there are times we work through devastating circumstances and it's in those times that I truly struggle. I do disagree with you about not being able to feel more than two energies at once because I am extremely sensitive and I can feel the emotions and energies of my entire "Pod". I have to constantly shield myself to be able to do my truly job. I'm very good at my job and controlling my empathy is a constant thing, a constant struggle. It does get tiring and I have to leave my shift and immerse myself in meditations to be able to "clear" myself of all the energies that I took on the night before. So I, in a whole, agree with you about it being not such a good thing in the medical field.
Empathy is not evil. It is a useful tool, which like most things, must be used in moderation. If you fully and completely empathize with every pt you are going to destroy yourself, but if you can be fully present and empathetic for say delivering bad news, and then move away from that as you see the next pt, then you can foster a much stronger relationship and trust with them, which ultimately leads to better adherence and better outcomes. Compassion w/o empathy --> Drs walking all over pt autonomy. Empathy protects that autonomy.
Absolutely Agree.. I left nursing due to “burn out,” 10years ago. I became a massage therapist and began practicing daily meditation...life is so different now. Wish I would have been introduced to meditation before or during nursing school....maybe it should be taught in school.
I am a hospice nurse and developed "compassion/empathy" fatigue. I did not want to be involved with human beings at all. I wanted to be alone, didn't want to leave my apartment. I felt that I had to absorb patient's/family's emotions (anger, anxiety, sadness, emotional pain) in order to be strong and assist them. I had to shut down. When I would get home, I had nothing left to give my family and myself. I pulled myself out of the field and into the communication/triage center. I am unfulfilled in this position. I will be moving and needing to find a new job. I want to go back to helping people heal and get better. I want to help people find their inner light in the face of adversity and help them develop it to become strong and increase their quality of life.
It is also possible that more women are diagnosed with depression vs men because men are less likely to express their feelings or seek help due to our cultural expectations.
I have felt emotionally drained on the day following clinicals (I'm a nursing student) and I usually take the whole next day to rest and recover & then I'm good to go but it's hard to imagine just going straight back to work the next day (like will be the case soon so I'm going to need to buck up and get some good coffee or something). I haven't had the strong empathetic connections with patients every clinical, but when I have had those, even though I feel drained the next day, I feel like I learned SO much from the patient/through the interactions with the patient. Sometimes it actually is the kind of encounters where I feel like, "this is why I am doing this and want to be in this field" & it's a very humbling feeling I can't quite put in words. I don't think that I reflected the patient's pain back on to them, so I guess that is not the definition of emotional empathy defined here... I guess it's the cognitive type of empathy but I definitely still feel like I FEEL some of what the patient is feeling. If you type in "Gladys Wilson and Naomi Feil", there's an amazing video of validation therapy that shows an amazing connection. Anyway This is a super interesting topic ! I just don't know HOW we can turn empathy off but I think just being more AWARE of it helps to draw those boundaries when they need to be drawn so that the patient gets better. But I will continue to focus on love, concern, AND COMPASSION rather than actually taking on the patient's pain... I'm not the patient, they are, but I still think it's a strength to feel with them on some level (maybe my thoughts on that will change when actually working, ha).
working in the er I see a lot of us start to really not care about the patients. do what we have to but just don't actually care. someone has told me I need more empathy but I feel like if I do my best for each patient to make them comfortable and what is needed than is that good enough or do I also have to feel bad for all of them? I still feel bad for certain patients but not all of them. this also has to do with how a lot of them treat us.
As a patient with chronic illness, I've experienced a lot of psycopathy from medical professionals. This discussion helped me to better understand the source of some of their behavior; empathy fatigue. Patients want to be heard, respected/believed, and understood. Cognitive empathy can certainly help with this but I hope the above can be achieved with compassion alone. Complete dismissal and outright disrespect of debilitatingly ill young women (as well as anyone who has iatrogenic illness) is unfortunately extremely common. I hope that discussions like this help doctors and nurses become more mindful of their own mental wellbeing so they can extend compassion to their patients, rather than increase their suffering. There is nothing worse than preparing for a doctor's appointment, struggling to get there (due to debilitating physical illness), and then being told there's nothing wrong with you and it's all in your head when you know for a fact that you have a very real physical illness. This is certainly not a compassionate response. I understand that there are illnesses and adverse events that need more scientific investigation and are not well understood but this doesn't make them any less real. Science can take time to catch up to what patients have been experiencing for years. Perhaps doctors respond this way because it is very frustrating to not be able to help their patient but belittling or dismissing them is not the answer. Thank you for listening and I hope hearing my perspective can help in some way.
My 10 yr old son is a true empath. Not just empathetic. I know that sounds whackadoo, but I'm telling you, if I shed a tear, he cries. Same with joy and happiness. And oddly enough, his best friend is the opposite. He's almost like a shield. I'm a nurse and I can't pick up on what he's feeling. All the other friends, no problem. But I think some people have an Antenna for others feelings.
I completely agree. I have never empathized with my patients. I sympathize with them. I used to think there was something wrong with me, but yay! I'm not the only one! (Not a psychopath, score!)
Truth about animals. My older cat's mother was left behind by her owners and she went looking for food and got herself stuck in a heating duct for about 3 weeks. My husband was finally able to get her out and she was scared, hungry, and had list most of her weight. She got a bath which was greatly appreciated and had alot of water and she just wanted to be alone and hide and instead of my older cat trying to hiss at her, she actually smelled her and backed off and both of my cats just kind of hovered over her.
My aunt accused me of having no sympathy or empathy after I finally went off on her after YEARS of her telling everyone that my cousin and I (being one of the few college educated ones in the family) murdered my grandmother by giving her morphine. Even though I had explained to her SEVERAL times in private why grandmother was ordered morphine and why it was given, she publicly told people on FB and other family members that I and my cousin killed her mother. Then she went as far to say that I had secret meetings and conversations with my cousin to plot this (my cousin was the POA). The private convos where my cousin saying "Hey, tell your sisters that Grandma isn't doing well." Super secret though *rolls eyes* But yes, calling her out after YEARS of this meant I'm the one with no empathy or sympathy. My grandmother had massive bilateral pleural effusions and end stage COPD. The morphine was a low dose for air hunger, which my aunt kept insisting my grandmother didn't have (even though she tried to hide it, the accessory muscle use was obvious) and she asked me several times why she couldn't catch her breath but my family forbade me from telling her.
Just cut her out of your life entirely. I have an aunt that accused me of (oddly) similar. I publicly explained my reasoning and told her that I was NOT going to listen to her disrespecting me or grandma ever again. When she speaks to me now, I calmly tell her that she's dead to me and she can either shut up and go away or I will leave/call the police and have her dragged off my property. One trip to the jail for refusing to get off my porch and she's learned to keep quiet.
As a nurse at a ward for severe illnesses I get this a lot. But also the other way around, relatives ask me to give more to end suffering. :( That's hard to take and/or explain why I can't do that. Even IF that could be the best treatment, it's up to the docs to order, for example, sedation. It all wears on you. But I love my job.
I think wishing people no suffering is something to expand on too. I would not wish suffering on someone but I can't say I would be the person I am without the suffering that has helped build me and strengthen me and even teach me about the world. from my standpoint I would wish for people in suffering to be lifted out. Although I grew so much from suffering I was not able to benefit from it without those who helped lift me out of it. also, I think you are touching on agape love a lot here, its a whole talk about agape, really.
Just a point on your observations regarding Jesus and suffering. It is not within us to "live up to" the price He paid. It is, rather in the acceptance of what His death on the cross offers us - namely grace. It is by His spirit that we do anything good and that can only be after we have accepted the gift. So yes, empathy is definitely a big part of this, but I would assert that it is not the garden variety kind where we are just feeling His pain. Rather, it is much more intimate than that, understanding that His pain was supposed to be ours. "The wages of sin is death, but the gift of God is eternal life through Christ Jesus." This is a great piece overall. My personality is so much empathy/sympathy/compassion. Understanding the differences and learning to have healthy boundaries has been so, so important for balance and my emotional and mental health. I am a grief collector by nature. Working in a Trauma ICU for 9 years was so much this and I didn't understand at the time that perhaps it was not the best place for me. Having said that, I see this aspect of my personality now as both a curse and my superpower - it's just learning how to manage it really. Anyway, thank you for your insight, Z Dogg. Always engaging and informative.
Remember that thing about surgeons having the similar rate of success despite fewer hours of sleep? I'm pretty sure that was fear motivated too. Fear of failure keeps them awake and focused.
There's a classic Star Trek episode entitled "The Empath." The mute titular empath literally felt the pains of others, something that adversely affected her ability to function as an effective person. If she were a HCW, she'd be burned out, working in administration, and saying, "work smarter, not harder."
I am half way through a MSW degree but I am having second thoughts about this profession. I am over 50, and I see a lot of problems in social work - loss of ethics, for-profit mentality creeping in, even cheating by students in my program..Empathy Is taught and emphasized but I wonder if that gets lost over time as people are overworked and just have to get through each day. I have to quit my steady job as a maintenance controller because I have to work 15 hours a week for four semesters at an unpaid internship and my job is not going to let me work part time. So at my age I have to find a part time job so I don't lose my apartment while studying, managing my money, and dealing with middle age fatigue. I have wanted to be a social worker for a long time and I am empathetic and want to specialize in geriatric care but I also worry about the direction social work is being pulled into by the for profit model. Especially when I hear about court appointed guardians stealing from the seniors they are supposed to care for. Ethics? Empathy? Why do people drop their empathy and ethics to steal from clients? It's scary to think I could lose my empathy over time and get pulled in to this behavior myself.
This is interesting. I believe this. But my compassion-empathy skills are blurry. How to separate? I feel like I am losing compassion and empathy was gone maybe 4 years ago.
Empathy can kill. I remember visiting an elderly dying friend several years ago, whose doctor had ordered morphine PRN. Before I arrived she was conscious and asking for relief. When I got there she slipped into sleep and began to actively die. Her niece, another nurse, was present. When the new-grad RN arrived with the morphine, I suggested she hold or waste it as I was convinced given the shallowness of E's breath that it would not be needed and could even cause the dear old lady's death. The niece, worrying that she would wake up again and experience the terrible pain of her cancer asked the nurse to give the push. Looking first at me timidly, and then at the niece, she did. One and one half minutes later my friend was gone... When I began nursing back in the 70's one of the first things our Superior told us was that if we were in nursing in order to "feel" our patients' pain and suffering and there from be better able to assist and care for them, then we'd better pack up and leave because we would do neither our patients nor ourselves any good. She was determined that we should be compassionate, but clinically detached. It took me a long time to retrain my native propensity to empathise, and the more I did, the more technically excellent I got. It saved me from the exhaustion many of my peers succumbed to. It also saved my patients because I did not care for them based on my emotions, but rather on a disinterested love hung upon high standards of practice. Is it hard? Yes. But it makes for better outcomes all around.
This was awesome! I'm gonna be a #CompassionWarrior from here on out. Whenever I'm in the charting hole, I say, "here I am clicking boxes! Living the dream!" Because of you.
Maybe empathy is good in limited doses. We shouldn't force ourselves to feel empathy or feel it for everyone, but does it mean we should stifle all empathy? Dr. Bloom has a point that empathy is selfish when it spotlights people we can relate to, but my unpopular opinion would be that being 0% selfish is a bit much.
Linda Ciccoli - so true. What bologna. Give those dying people some Morphine or willow bark, or whatever. Where's that study on how prayer is harmful in healthcare situations? I don't feel like googling. 🙃
This is a common mistake many make when looking at Mother Teresa. One must understand that she saw a lot of suffering. In order to cope with it, she had to contextualize it in terms that she could deal with. This the suffering becomes in a way a source of hope. Sadly, most westerners are too comfortable and can afford to freak out at the least amount of suffering.
Mother Theresa by all definition was a psychopath. Thanks for this discussion, I love this topic. As a physician I feel that empathy shows a profound disrespect for the patient. You are effectively saying that they can't handle their situation and only by sacrificing with your own pain can they handle their lot. Further more, how could you ever be objective if you "feel their pain"?
Mother Theresa was not a psychopath, nor an unfeeling person. Her love for God was the basis of her love for those poorest persons she and her sisters went into the gutters and streets to rescue from a filthy, abandoned death. Give them morphine? Her nurses did, when they had any. Persons who've never missioned in such a world have no right to judge her. She had more compassion in her wrinkled hands than most have in their whole body. Take your complaints to the slums, among the homeless, mentally ill, filthy, sick and dying and then tell me what for.
"Turn it off, like a light switch just go *click*!! It's a cool little Mormon trick" xD ZDoggMD I am disappoint, you missed the perfect musical opportunity
This is so fucking good. :) Thanks for the explanation. I'm a nurse that can't stand my family when I get home from work and I sleep up to 14 hours at the time.
I feel that "I got nothing left" coming home all the time. I'm angry, cranky, miserable and just in a bad mood. I'm an RN and I have such irritation over shot like complaints of room size and food. I want to say, "does your insurance pay for you to have a bigger room and gourmet food." I'm competent and I have to buffer lots of Doc/Pt interactions. It'd be so. Ice of docs could be on the same team. If we're taking a hardline on say "drug-seeking", I can be on that train. Nurses use what's the Nursing Network to find the best specialist in the area. Cause we know. We never want the hand holder with no clinical skill. We'll take the absolute dick with skill over the hand- holder. PS- Empathic and empathetic are different.
So, I remember telling my nurses "I've lost my empathy" Did it make me less caring? I think not: I just admitted it was gone. A lot of my colleagues are so negative when I say this like I've become a serial killer... Oh and Han Solo needs a Bow Tie.
Sorry Dr. Z, I am a Buddhist, Nam Myoho Renge Kyo, we study Buddhism, we are CONNECTED to everyone and everything, making GOOD KARMA is very important, better to STUDY about NAM MYOHO RENGE KYO, Black, White, Brown, Yellow, we are all the SAME, we all SUFFER the same, this is why we all need NAM MYOHO RENGE KYO, bro look up the SGI, the Soka Gakkai International.
I just found out on FB from a friends page that I am an Intuitive Empath. I'm 46yrs old and in the last 10yrs of going to psychiatrist and Drs but never having this diagnoses. So I'm homeless due to I think half of wanting it and I think because maybe I'm going thru a "burnout"!?? I don't know but I've attempted suicide more than 4 times in my life time and I was never a Dr but I was a cargiver for the DHS office in Michigan here and for many family members!! I'm so tired and suck and I need help! How and what do I need to do??
One advise: stop using clickbait format titles. This throws people off and discourages sensible people from watching your show. They leave comments without actually watching. Good points covered, though.
What if empathy is a Darwinian survival trait? Results in optimizing local conditions for the local group of a species... sometimes at the expense of the other group.
This is all just too much to remember, so I split the difference and feel absolutely nothing for my patients. Or myself. I just come home from work and drink vodka in the basement while staring at a brick wall.
Jesus was trying to help humanity but he still did not know about NAM MYOHO RENGE KYO and got persecuted and killed. Study about Nichiren Daishonin, he found Nam Myoho Renge Kyo and the entire Japanese nation even now, respects him and knows about Nam Myoho Renge Kyo, look up the history of the Soka Gakkai and the SGI. Nam Myoho Renge Kyo is the KEY TO THE UNIVERSE, it is the compassion of the ORIGINAL BUDDHA. Nam Myoho Renge Kyo!!!
I'm highly-HIGHLY empathic and work in healthcare & social work. I'm suffering from empathy fatigue 💯. I clicked on this video 99% sure that I would hate it. I was dead wrong. I feel like I was just diagnosed. I've just realized that empathy is not my superpower, it's my kryptonite. Time to re-boot & reprogram. Thanks guys.
+Catie and the Bo Peeps I feel you Catie...
Catie and the Bo Peeps I'm exactly the same. Too much so in my OT work, too much with my 3 teenaged daughters and then I have NOTHING left for my husband. Not his fault, mine. I need to change things. This video has really helped me.
Same here. I burned out. I felt like I was being fed on by a relentless vampire hoard. That is what working in healthcare felt like to me. No matter how much I gave, it was never enough. It’s an extremely unrewarding environment. Its impossible to want to come to work when feedback is nonstop negative. I turned really negative and toxic. Had nothing in the tank anymore for anyone and a big case of resentment 6 years ago. I’ve started to think about getting back in via temp agency. Maybe it’s doable in fixed three month chunks.
I was very wary of this video going into it. I'm a genetic counselor and empathy is highly valued and highly praised. But in listening to you, the difference between cognitive empathy and emotional empathy is so key. Emotional empathy will certainly be an emotional burden for the caregiver and it also keeps caregivers from caring for their patient: how can you be a support to your patient if you yourself are suffering over their situation? It also takes you away from your family and friends. But cognitive empathy - knowing what the patient's perspective is, what factors are influencing their state of mind and medical decision-making - that is priceless for patient care.
This is well articulated, and much more common than people realize. Superficially one would think that patients want their key decision makers to be emotionally invested. However it is insightful to note that what they really want is the clear thinking of a person who can control emotion and steer the plane home. The hard part comes when the pilot needs to honestly tell a passenger that his plane is going to crash.
many of my co-workers give me a hard time about my lack of empathy. I do have compassion for my patients but, I feel the times I have empathized with a patient/ family it is very draining emotionally and physically.
I had to take a break from PICU after the ICU-death of my father. The reminders were constant and the emotions too raw and I could barely get through my shifts. I spent a year in Newborn nursery, and returned to PICU when I was healed enough to give again. In the meantime one of my former co-workers took her own life by drug-overdose. I am so thankful that the right opportunity came up at the right time for me and I was surrounded by a supportive administration and staff.
This is how I see the semantics.
Sympathy= I know what you're going through
Empathy= I can understand why you feel that way
Compassion= What can I do to make make it better.
As a nurse I try to stick with compassion because I can do my job without becoming too emotionally invested
10 years of hospice nursing I burnt out to the point of physical illness. I was very empathetic but every 6 months I would shut down to be able to survive.
ines velazquez I feel anxiety about going to work. It's a killer.
I find this interesting because I’m in nursing school, and my nursing school is highly affiliated with the Cleveland Clinic and University Hospitals. And they taught us to NEVER have empathy for patients because it’s a bad thing. In my nursing school they are drilling it into us that empathy is bad, compassion and sympathy is good. “When you’re empathetic you are useless, when you are sympathetic you are useful” is what they always tell me. So I find it strange to hear you say the Cleveland Clinic at one point encouraged empathy. They must have dramatically changed something in the past few years.
An excerpt from a FB post I wrote: if it's life or death, give me the nurses and doctors who are all science and logic. I don't want them seeing me as someone who could be their mother, daughter, sister...I don't want them losing their shit while they're trying to save my life. There's a reason physicians don't treat family members. Depersonalization is a necessary evil for objectivity. So please think before you say to a medical professional, "Imagine if that was your child back there." In order to receive the BEST care that's the last thing you want your medical team thinking about.
I agree, but some of this is more semantic than genuine disagreement. Most people don't necessarily distinguish among all the different words -- empathy, compassion, sympathy -- though I totally agree that TRUE compassion does not "fatigue" because the giver receives and the receiver gives, even in the moment of exchange. The great Tibetan monk (and French PhD in molecular genetics) Mattieu Ricard calls it "empathic distress" -- the one that wears us out. Over-feeling for another renders the would-be helper less effective (and leads to so-called "compassion fatigue"). I can be compassionate toward someone without losing the boundary between their suffering and my emotional response to their suffering. I do them more good by trying to understand their suffering and by non-judgmentally DESIRING THEIR WELLBEING (I like ZDogg's use of "love"). At the Cleveland Clinic, we are working hard to feel just enough to make us act on behalf of the suffering other, to DO whatever we can to relieve it, without over-feeling to the point of paralysis, personal drain or, worse, repugnance. If we see compassion as a source of recharging our own batteries and DOING something -- not just feeling -- everyone benefits. Let's not argue about which word we use -- let's just do it.
Rev. Amy Greene, Director of Spiritual Care, Cleveland Clinic
This is so releveant to social work and education. watched it a few years ago when I was still in school and didnt get it - now that I have worked in education and do work in social services I completly get, Having experianced empathy fatigue many times and trying to tune down my empathy (with mixed results). Id say that all helping proffesions - Medicine, education and Social services/welfare are all part of te same tribe of people who experiance warzones worth of tragedy every day. some of us, such as myself, do this work in a literal warzone too. Thanks Zdogg, this video and alot of other videos on the channel are realy helpful - keep up the good work.
I agree with much of what you're saying, however I think there are situations where empathy can actually provide a diagnostic advantage. As a neurologist, I encounter many conditions that patients have difficulty conveying. Many times narrowing my differential diagnoses requires teasing out subtleties that are best achieved through empathy. I think that neurology and psychiatry are the most readily understood applications of empathy as a diagnostic tool, however I think it can be used effectively by other clinicians as well. Even so, using empathy in this way has its limitations and can absolutely lead physicians astray if not appropriately checked.
Thank you so much for this video. I will always keep this in mind.
I like how you explained your viewpoint very clearly and with good arguments and I think this can really help a lot of people because it's always good to hear the downside of something considered to be a virtue in healthcare because it's important to hear things from two sides.
I know this video will help me as well to be able to become a better healthcare practitioner because I think that if you feel good about your job emotionally, you will be able to help your patients the best.
So thank you!
I'm going to be a better Nurse because of you Dr. Z!! Im my second semester of core ADN classes now and I watch you in all my free time!! thank you for sharing your wealth of experience and knowledge with all of us other folk!!
Nail on head! Great point and discussion today Dr ZDogg.
I'm currently in medical school and they're so pushing this version of empathy. While well intentioned it becomes virtue signaling and different from true compassion. Again great topic, love the new show
YES!!! empathy fatigue !!! I can fake it but I have a wall up. So much suffering, I feel like I have compassion but I never let it get to me.
very interesting topic - i have found over the years as a primary care, keeping a distance/preventing empathy helps keep me from burning out as bad, and helps me remain compassionate - kudos
I took care of an elderly former nurse who's children refused to make her a DNR as she was dying. She was coded several times and then put on a ventilator. I could sense she was wanting to just be comfortable and be allowed to die. I spoke with her children 3 times to allow her to be a DNR comfort care and they still refused. I felt so helpless to go 9th what I was sensing from the patient. Finally she passed and the feeling in the room from her was at a peace. I cried because she was finally at peace and no longer suffering. It felt like she was family and I grieved form her fro several weeks. I still went on the care for other patients the remained of the day and felt more compassion for the remaining patients.
I'm just a human (I do have a phd in Dr.Mom) personally, I am paralyzed by my empathy. It is almost an obsession with me. I have paralyzing anxiety..I think it's just because I've been through so much. I wish I wasn't that way. I appreciate compassion, kindness and humor with my doctors but I HOPE they don't feel empathetic for me...that saps the energy from their brain and they might miss something that could save my life!
beautiful episode
TLDR: define your terms, mediate on love and compassion, heal others
#inZweTrust
I'll admit it - I was ready to get on my high horse when I read the title of this video lol. Excellent points - when I'm a student RN & did a placement in palliative care. There was a young girl with a bowel obstruction. I sat with her all night during the night shift, holding her hand while she wailed & moaned in pain. She was from overseas & had no family or friends around. I was beside myself thinking about what she was going through - I wanted to distance myself from patients after that. If you take all your patient's troubles on, you're just going to get burnt out & be a shitty health care provider.
I agree with using your definition of compassion instead of empathy. You need to have the desire to be with and help others in the face of their suffering, but i you can't take that home. You're right, nursing school certainly hammers empathy into our heads. I even got odd looks from my cohort when i said you can't truly care about your patients as in taking on their pain. I think compartmentalization is not talked about enough in school. We spend years busting our ass to learn how to care about others, and very little time learning how to take care of ourselves in the process.
As an empath in the medical field, in the NICU to be exact, I have to agree with you. I struggle with taking on the energies of everyone around me. Emotions are already high on our unit but there are times we work through devastating circumstances and it's in those times that I truly struggle.
I do disagree with you about not being able to feel more than two energies at once because I am extremely sensitive and I can feel the emotions and energies of my entire "Pod".
I have to constantly shield myself to be able to do my truly job. I'm very good at my job and controlling my empathy is a constant thing, a constant struggle. It does get tiring and I have to leave my shift and immerse myself in meditations to be able to "clear" myself of all the energies that I took on the night before.
So I, in a whole, agree with you about it being not such a good thing in the medical field.
Not a medical professional, but a foster mom. I really needed to hear this today.
Empathy is not evil. It is a useful tool, which like most things, must be used in moderation. If you fully and completely empathize with every pt you are going to destroy yourself, but if you can be fully present and empathetic for say delivering bad news, and then move away from that as you see the next pt, then you can foster a much stronger relationship and trust with them, which ultimately leads to better adherence and better outcomes. Compassion w/o empathy --> Drs walking all over pt autonomy. Empathy protects that autonomy.
It's 'walk a mile in someone elses shoes', not 'wear their shoes home'.
Absolutely Agree.. I left nursing due to “burn out,” 10years ago. I became a massage therapist and began practicing daily meditation...life is so different now. Wish I would have been introduced to meditation before or during nursing school....maybe it should be taught in school.
I am a hospice nurse and developed "compassion/empathy" fatigue. I did not want to be involved with human beings at all. I wanted to be alone, didn't want to leave my apartment. I felt that I had to absorb patient's/family's emotions (anger, anxiety, sadness, emotional pain) in order to be strong and assist them. I had to shut down. When I would get home, I had nothing left to give my family and myself. I pulled myself out of the field and into the communication/triage center. I am unfulfilled in this position. I will be moving and needing to find a new job. I want to go back to helping people heal and get better. I want to help people find their inner light in the face of adversity and help them develop it to become strong and increase their quality of life.
It is also possible that more women are diagnosed with depression vs men because men are less likely to express their feelings or seek help due to our cultural expectations.
Thanks ZDogg. I practiced empathy instead of compassion for 18 years as an RN. ...burned out around year 7-10. Healing nicely now...
I have felt emotionally drained on the day following clinicals (I'm a nursing student) and I usually take the whole next day to rest and recover & then I'm good to go but it's hard to imagine just going straight back to work the next day (like will be the case soon so I'm going to need to buck up and get some good coffee or something). I haven't had the strong empathetic connections with patients every clinical, but when I have had those, even though I feel drained the next day, I feel like I learned SO much from the patient/through the interactions with the patient. Sometimes it actually is the kind of encounters where I feel like, "this is why I am doing this and want to be in this field" & it's a very humbling feeling I can't quite put in words. I don't think that I reflected the patient's pain back on to them, so I guess that is not the definition of emotional empathy defined here... I guess it's the cognitive type of empathy but I definitely still feel like I FEEL some of what the patient is feeling. If you type in "Gladys Wilson and Naomi Feil", there's an amazing video of validation therapy that shows an amazing connection. Anyway This is a super interesting topic ! I just don't know HOW we can turn empathy off but I think just being more AWARE of it helps to draw those boundaries when they need to be drawn so that the patient gets better. But I will continue to focus on love, concern, AND COMPASSION rather than actually taking on the patient's pain... I'm not the patient, they are, but I still think it's a strength to feel with them on some level (maybe my thoughts on that will change when actually working, ha).
working in the er I see a lot of us start to really not care about the patients. do what we have to but just don't actually care. someone has told me I need more empathy but I feel like if I do my best for each patient to make them comfortable and what is needed than is that good enough or do I also have to feel bad for all of them? I still feel bad for certain patients but not all of them. this also has to do with how a lot of them treat us.
As a patient with chronic illness, I've experienced a lot of psycopathy from medical professionals. This discussion helped me to better understand the source of some of their behavior; empathy fatigue. Patients want to be heard, respected/believed, and understood. Cognitive empathy can certainly help with this but I hope the above can be achieved with compassion alone. Complete dismissal and outright disrespect of debilitatingly ill young women (as well as anyone who has iatrogenic illness) is unfortunately extremely common. I hope that discussions like this help doctors and nurses become more mindful of their own mental wellbeing so they can extend compassion to their patients, rather than increase their suffering. There is nothing worse than preparing for a doctor's appointment, struggling to get there (due to debilitating physical illness), and then being told there's nothing wrong with you and it's all in your head when you know for a fact that you have a very real physical illness. This is certainly not a compassionate response. I understand that there are illnesses and adverse events that need more scientific investigation and are not well understood but this doesn't make them any less real. Science can take time to catch up to what patients have been experiencing for years. Perhaps doctors respond this way because it is very frustrating to not be able to help their patient but belittling or dismissing them is not the answer. Thank you for listening and I hope hearing my perspective can help in some way.
I have been preaching about needing more empathy from everyone. Zdogg is correct. What I mean Is COMPASSION!
Excellent point Doc, in being able to differentiate the difference between empathy and compassion.
My 10 yr old son is a true empath. Not just empathetic. I know that sounds whackadoo, but I'm telling you, if I shed a tear, he cries. Same with joy and happiness. And oddly enough, his best friend is the opposite. He's almost like a shield. I'm a nurse and I can't pick up on what he's feeling. All the other friends, no problem. But I think some people have an Antenna for others feelings.
I completely agree. I have never empathized with my patients. I sympathize with them. I used to think there was something wrong with me, but yay! I'm not the only one! (Not a psychopath, score!)
What a great presentation. Unique approach to the discussion of burnout. Thank you so much
Truth about animals. My older cat's mother was left behind by her owners and she went looking for food and got herself stuck in a heating duct for about 3 weeks. My husband was finally able to get her out and she was scared, hungry, and had list most of her weight. She got a bath which was greatly appreciated and had alot of water and she just wanted to be alone and hide and instead of my older cat trying to hiss at her, she actually smelled her and backed off and both of my cats just kind of hovered over her.
My aunt accused me of having no sympathy or empathy after I finally went off on her after YEARS of her telling everyone that my cousin and I (being one of the few college educated ones in the family) murdered my grandmother by giving her morphine. Even though I had explained to her SEVERAL times in private why grandmother was ordered morphine and why it was given, she publicly told people on FB and other family members that I and my cousin killed her mother. Then she went as far to say that I had secret meetings and conversations with my cousin to plot this (my cousin was the POA). The private convos where my cousin saying "Hey, tell your sisters that Grandma isn't doing well." Super secret though *rolls eyes* But yes, calling her out after YEARS of this meant I'm the one with no empathy or sympathy.
My grandmother had massive bilateral pleural effusions and end stage COPD. The morphine was a low dose for air hunger, which my aunt kept insisting my grandmother didn't have (even though she tried to hide it, the accessory muscle use was obvious) and she asked me several times why she couldn't catch her breath but my family forbade me from telling her.
Just cut her out of your life entirely. I have an aunt that accused me of (oddly) similar. I publicly explained my reasoning and told her that I was NOT going to listen to her disrespecting me or grandma ever again. When she speaks to me now, I calmly tell her that she's dead to me and she can either shut up and go away or I will leave/call the police and have her dragged off my property. One trip to the jail for refusing to get off my porch and she's learned to keep quiet.
As a nurse at a ward for severe illnesses I get this a lot. But also the other way around, relatives ask me to give more to end suffering. :( That's hard to take and/or explain why I can't do that. Even IF that could be the best treatment, it's up to the docs to order, for example, sedation. It all wears on you. But I love my job.
I think wishing people no suffering is something to expand on too. I would not wish suffering on someone but I can't say I would be the person I am without the suffering that has helped build me and strengthen me and even teach me about the world. from my standpoint I would wish for people in suffering to be lifted out. Although I grew so much from suffering I was not able to benefit from it without those who helped lift me out of it.
also, I think you are touching on agape love a lot here, its a whole talk about agape, really.
Just a point on your observations regarding Jesus and suffering. It is not within us to "live up to" the price He paid. It is, rather in the acceptance of what His death on the cross offers us - namely grace. It is by His spirit that we do anything good and that can only be after we have accepted the gift. So yes, empathy is definitely a big part of this, but I would assert that it is not the garden variety kind where we are just feeling His pain. Rather, it is much more intimate than that, understanding that His pain was supposed to be ours. "The wages of sin is death, but the gift of God is eternal life through Christ Jesus." This is a great piece overall. My personality is so much empathy/sympathy/compassion. Understanding the differences and learning to have healthy boundaries has been so, so important for balance and my emotional and mental health. I am a grief collector by nature. Working in a Trauma ICU for 9 years was so much this and I didn't understand at the time that perhaps it was not the best place for me. Having said that, I see this aspect of my personality now as both a curse and my superpower - it's just learning how to manage it really. Anyway, thank you for your insight, Z Dogg. Always engaging and informative.
I empathize with pt's that are suffering but are actually doing something to help themselves. Beyond that I just do my job
Remember that thing about surgeons having the similar rate of success despite fewer hours of sleep? I'm pretty sure that was fear motivated too. Fear of failure keeps them awake and focused.
There's a classic Star Trek episode entitled "The Empath." The mute titular empath literally felt the pains of others, something that adversely affected her ability to function as an effective person. If she were a HCW, she'd be burned out, working in administration, and saying, "work smarter, not harder."
28:00-29:00 is a great summation of the doctor’s role at the bedside
This was a good live discussion on fb. Keep them coming
What I tell my daughter every day..... you can feel for people without feeling FOR people..
I am half way through a MSW degree but I am having second thoughts about this profession. I am over 50, and I see a lot of problems in social work - loss of ethics, for-profit mentality creeping in, even cheating by students in my program..Empathy Is taught and emphasized but I wonder if that gets lost over time as people are overworked and just have to get through each day. I have to quit my steady job as a maintenance controller because I have to work 15 hours a week for four semesters at an unpaid internship and my job is not going to let me work part time. So at my age I have to find a part time job so I don't lose my apartment while studying, managing my money, and dealing with middle age fatigue. I have wanted to be a social worker for a long time and I am empathetic and want to specialize in geriatric care but I also worry about the direction social work is being pulled into by the for profit model. Especially when I hear about court appointed guardians stealing from the seniors they are supposed to care for. Ethics? Empathy? Why do people drop their empathy and ethics to steal from clients? It's scary to think I could lose my empathy over time and get pulled in to this behavior myself.
Me too!!!
Bad movies, violent ones injure me!
When my books end I go into a depression
This is interesting. I believe this. But my compassion-empathy skills are blurry. How to separate? I feel like I am losing compassion and empathy was gone maybe 4 years ago.
Empathy can kill. I remember visiting an elderly dying friend several years ago, whose doctor had ordered morphine PRN. Before I arrived she was conscious and asking for relief. When I got there she slipped into sleep and began to actively die. Her niece, another nurse, was present. When the new-grad RN arrived with the morphine, I suggested she hold or waste it as I was convinced given the shallowness of E's breath that it would not be needed and could even cause the dear old lady's death. The niece, worrying that she would wake up again and experience the terrible pain of her cancer asked the nurse to give the push. Looking first at me timidly, and then at the niece, she did. One and one half minutes later my friend was gone... When I began nursing back in the 70's one of the first things our Superior told us was that if we were in nursing in order to "feel" our patients' pain and suffering and there from be better able to assist and care for them, then we'd better pack up and leave because we would do neither our patients nor ourselves any good. She was determined that we should be compassionate, but clinically detached.
It took me a long time to retrain my native propensity to empathise, and the more I did, the more technically excellent I got. It saved me from the exhaustion many of my peers succumbed to. It also saved my patients because I did not care for them based on my emotions, but rather on a disinterested love hung upon high standards of practice. Is it hard? Yes. But it makes for better outcomes all around.
This was awesome! I'm gonna be a #CompassionWarrior from here on out. Whenever I'm in the charting hole, I say, "here I am clicking boxes! Living the dream!" Because of you.
Thank you for this food for thought! I am also totally the same when it comes to violent movies and dark subject matter in tv/movies/etc.!
Maybe empathy is good in limited doses. We shouldn't force ourselves to feel empathy or feel it for everyone, but does it mean we should stifle all empathy? Dr. Bloom has a point that empathy is selfish when it spotlights people we can relate to, but my unpopular opinion would be that being 0% selfish is a bit much.
Funny you mention Mother Theresa, who actually felt no empathy or compassion and thought everyone should suffer.
"Oh you're feeling alot of unbearable pain because Jesus is kissing you"
"Well tell Jesus to stop kissing me"
"lol k"
rip
Linda Ciccoli - so true. What bologna. Give those dying people some
Morphine or willow bark, or whatever. Where's that study on how prayer is harmful in healthcare situations? I don't feel like googling. 🙃
This is a common mistake many make when looking at Mother Teresa. One must understand that she saw a lot of suffering. In order to cope with it, she had to contextualize it in terms that she could deal with. This the suffering becomes in a way a source of hope.
Sadly, most westerners are too comfortable and can afford to freak out at the least amount of suffering.
Mother Theresa by all definition was a psychopath. Thanks for this discussion, I love this topic. As a physician I feel that empathy shows a profound disrespect for the patient. You are effectively saying that they can't handle their situation and only by sacrificing with your own pain can they handle their lot. Further more, how could you ever be objective if you "feel their pain"?
Mother Theresa was not a psychopath, nor an unfeeling person. Her love for God was the basis of her love for those poorest persons she and her sisters went into the gutters and streets to rescue from a filthy, abandoned death. Give them morphine? Her nurses did, when they had any. Persons who've never missioned in such a world have no right to judge her. She had more compassion in her wrinkled hands than most have in their whole body. Take your complaints to the slums, among the homeless, mentally ill, filthy, sick and dying and then tell me what for.
"Turn it off, like a light switch just go *click*!! It's a cool little Mormon trick" xD
ZDoggMD I am disappoint, you missed the perfect musical opportunity
Nailed it!! Z! Wow!!! Your so right.. burns you out...
This is so fucking good. :) Thanks for the explanation.
I'm a nurse that can't stand my family when I get home from work and I sleep up to 14 hours at the time.
Burnout is real, and empathy fatigue is just the tip of the iceberg.
"Emotional empathy" would seem to hinder any professional.
I think people confuse empathy and compassion.
Burnout is one of the reasons why some are in education instead of /in addition to bedside nursing.
Empathy- The ability to see where someone is coming from but not agreeing with them .
I feel that "I got nothing left" coming home all the time. I'm angry, cranky, miserable and just in a bad mood. I'm an RN and I have such irritation over shot like complaints of room size and food. I want to say, "does your insurance pay for you to have a bigger room and gourmet food."
I'm competent and I have to buffer lots of Doc/Pt interactions. It'd be so. Ice of docs could be on the same team. If we're taking a hardline on say "drug-seeking", I can be on that train.
Nurses use what's the Nursing Network to find the best specialist in the area. Cause we know. We never want the hand holder with no clinical skill. We'll take the absolute dick with skill over the hand- holder.
PS- Empathic and empathetic are different.
So, I remember telling my nurses "I've lost my empathy" Did it make me less caring? I think not: I just admitted it was gone. A lot of my colleagues are so negative when I say this like I've become a serial killer...
Oh and Han Solo needs a Bow Tie.
Damn Zdogg is like a pastor for the medical world. 😂❤
Dr Z doesn’t wear suits anymore :-) He doesn’t stand when he talks either. His style has changed over the years. You look good either way doc!
you should change up Han Solo's Tie once in a while ☺ just a thought
I tell my husband all the time. " I have used up all my nice today"
Sorry Dr. Z, I am a Buddhist, Nam Myoho Renge Kyo, we study Buddhism, we are CONNECTED to everyone and everything, making GOOD KARMA is very important, better to STUDY about NAM MYOHO RENGE KYO, Black, White, Brown, Yellow, we are all the SAME, we all SUFFER the same, this is why we all need NAM MYOHO RENGE KYO, bro look up the SGI, the Soka Gakkai International.
I just found out on FB from a friends page that I am an Intuitive Empath. I'm 46yrs old and in the last 10yrs of going to psychiatrist and Drs but never having this diagnoses. So I'm homeless due to I think half of wanting it and I think because maybe I'm going thru a "burnout"!?? I don't know but I've attempted suicide more than 4 times in my life time and I was never a Dr but I was a cargiver for the DHS office in Michigan here and for many family members!! I'm so tired and suck and I need help! How and what do I need to do??
Al-Anon - teaches detached love.
I'd prefer Doc Vader talking about empathy xD
One advise: stop using clickbait format titles. This throws people off and discourages sensible people from watching your show. They leave comments without actually watching. Good points covered, though.
Empathy = Insight.
Very informative; thanks
Wow...getting deep
i wish someone had told me this stuff before i began 3rd year of med school, instead of having had to learn this the hard way haha
Love this video.
Is Tom wearing shorts with his suit top??
Cancer doesn't care about your feelings.
What if empathy is a Darwinian survival trait? Results in optimizing local conditions for the local group of a species... sometimes at the expense of the other group.
AMA = against medical advice should be a uniform of THE HOODIE! No SUIT SUNDAY!
This is all just too much to remember, so I split the difference and feel absolutely nothing for my patients. Or myself. I just come home from work and drink vodka in the basement while staring at a brick wall.
Jesus was trying to help humanity but he still did not know about NAM MYOHO RENGE KYO and got persecuted and killed. Study about Nichiren Daishonin, he found Nam Myoho Renge Kyo and the entire Japanese nation even now, respects him and knows about Nam Myoho Renge Kyo, look up the history of the Soka Gakkai and the SGI. Nam Myoho Renge Kyo is the KEY TO THE UNIVERSE, it is the compassion of the ORIGINAL BUDDHA. Nam Myoho Renge Kyo!!!
Oh and also empaths (Star Trek)
www.imdb.com/title/tt0708462/
Yesssssss
PTSD
I Wuv you 3
You look tired Z.
Hey it's Young Uncle Fester
crossed a line buddy...no more zdogg for me