Fondazione Zoé

A comment in response to the Giovanna Ruberto’s story “Margaret and balls of wool”.

I read Margaret’s story about her encounter with Sylvia, a terminally-ill patient whilst she was an aspiring nurse attentively and I felt some kind of acute turmoil from Giovanna Ruberto’s introductory words (Zoé Blog 27/03/2013) to which I felt linked by friendship and esteem: ‘in hospitals lives cross, at times relationships even friendships develop and so interacting with a patient is not a neutral act if you are real and human it changes you’.


I don’t know if Margareet realized that her story retraces almost faithfully the four stages of burnout syndrome (literally: to burn yourself out).

1) The first stage is that of idealistic enthusiasm that strikes people who dedicate themselves to a caring profession, in our case doctors and nurses. Listening to Margaret’s words: ‘I am shivering, eager to meet the disease par excellence, cancer.’ Idealistic, perhaps excessive enthusiasm. 

2) The second phase is characterized by the stagnation that encroaches when the fruit of our labour does not yield the desired results. 

3) The unhelpfulness of the job and the efforts made brings you to the third phase, which is frustration. Listen to how these two phases are inextricably linked in the story: “I’m dying, Maggie” says Sylvia and Margaret in turn thinks ‘If so all that we have shared would also leave. If so a piece of my life would also be taken with her.’ We don’t feel perhaps the full unhelpfulness of the work we have carried out and the frustration that doesn’t allow her to recognize that, at the end of the story, her efforts were hopeless? 

4) And so we have arrived at the fourth stage of the syndrome, apathy, indifference. Sylvia dies and Margaret does not find the courage to return to that room because she knows that she will find it empty, even she feels empty inside. You breathe a sigh of relief on knowing that Margaret became in the meantime a professional nurse that she didn’t burnout on her first encounter with suffering but certainly her courage and excessive enthusiasm up to unconsciousness, did not invite bad predictions. However, the angelic aspect is by the by here, Margaret must be tough if she was capable of retaking the difficult journey which has led her to undertake her work calmly, an indispensable quality in continuing such an exhausting and difficult career, which I hope in her case will be long and prosperous.

At the cost of appearing pedantic I would like to however, on this occasion however opportune it may be, reiterate some convictions that I share with many health communication experts.
Whoever desires to be a help to others, in this case doctors and nurses in the cases of patients, they cannot allow themselves to feel sympathetic or antipathetic. If for antipathy the concept is immediately understandable in how much feeling arises from distance or repulsion, I think that sympathy needs a bit more explanation.

Sympathy (literally: to endure- suffer together) means sharing emotions such as suffering but also joy or desire. It is therefore a spontaneous, emotional response, a feeling that can bring an excessive closeness to involvement and any joint suffering in the care relationship will be fought.

Empathy is instead the right tool to be aware of and to use, a tool and not feeling that serves to regulate the just distance between those who care and the patient. Whilst seeking to understand their state of mind or furthermore offering attention and help. ‘I understand your suffering, I am attempting to imagine it but I cannot try to feel all that you feel. This doesn’t impede my ability to look humanely at your problems and share your emotions to help you improve the quality of our relationship.’ It isn’t identification, you don’t suffer together.

To conclude: friends had said to Margaret: ‘Listen, understand, alleviate, console’. Perfect, it is this that makes a good doctor or a good nurse! But also ‘taking it upon yourself, takes away the pain’. This is wrong, if you behave like this you will burnout.

It is true, my dear Giovanna, that the relationship with a patient if you are human changes you, but this relationship must be most neutral as possible and if a friendship or something else must arise, it is better if it grows once the patient is discharged.




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